Question 1
All of the following apart from which muscle is typically affected in saturday night palsy (compression of the radial nerve at the spiral groove) ?
(A) Supinator
(B) Extensor carpi ulnaris
(C) Triceps
(D) Brachoradialis
(E) Extensor pollicus longus
C: Whilst the triceps is innervated by the radial nerve, branches supplying it occur proximal to the spiral groove.
Question 2
What is TRUE regarding the posterior interosseous nerve?
(A) It is a deep branch of the radial nerve and is purely motor
(B) It is a superficial branch of the radial nerve and is purely sensory
(C) It is a branch of the median nerve
(D) It is a branch of the axillary nerve
(E) It is a branch of the ulnar nerve and is purely motor
A: The radial nerve branches into superficial and deep branches as it passes into the forearm. The superficial branch is sensory, affecting the skin around the anatomical snuffbox. The deep branch is purely motor, effecting the extensor compartment of the forearm and including the supinator
Question 3
Which of the following features reliably distinguishes posterior interosseous syndrome from radial nerve compression at the spiral groove on the humerus?
(A) Absence of sensory involvement
(B) Weakness in supination
(C) Weakness in finger extension
(D) Weakness in little finger abduction
(E) Weakness in finger flexion
A: The posterior interosseous nerve is a branch of the radial nerve, and is purely motor. It may be compressed as it passes underneath the supinator muscle (which it innervates). Finger extension is provided by extensor digitorum, extensor indicis, extensor digiti minimi. Wrist drop is characteristically absent, because extensor carpi radialis longus and brevis is supplied by the radial nerve prior to branching of the superficial and deep (posterior interosseous nn). The ulnar nn suplies little finger abduction, and finger flexion is provided by the median nn.
Question 4
Supination is provided by which of the following muscles and nn combination?
(A) Supinator and ulnar nn
(B) Biceps and musculocutaneous nn
(C) Brachoradialis and radial nn
(D) coracobrachialis and axillary nn
(E) Serratus anterior and long thoracic nn
B: The supinator is supplied by the posterior interosseous nn, which is the purely motor deep branch of the radial nn.
Question 5
The anterior interosseous nerve is a purely motor nerve. Which of the following is FALSE regarding its anatomy?
(A) It is a motor branch of the median nerve
(B) It branches in the forearm
(C) It supplies flexor pollicis brevis
(D) It supplies pronator quadratus
(E) It supplies flexor digitorum profundis I and II
C: This is supplied by another branch of the median nerve which passes deep to the flexor retinaculum. The anterior interosseous nn is purely motor, and it inervates pronator quadratus, flexor pollicis longus, flexor digitorum profondus I and II.
Question 6
Meralgia paresthetica is a syndrome involving the lateral cutaneous nerve of the thigh. Which of the following statements is FALSE
(A) It is a purely sensory branch of the lumbar-sacral plexus
(B) It is derived from L2, L3
(C) It passes close to the inguinal ligament
(D) It is characterised by numbness and tingling in the ventromedial aspect of the thigh
(E) It is associated with obesity
D: All the other statements are TRUE, however, the lateral cutaneous nerve of the thigh supplies sensation to the ventrolateral surface of the thigh.
Question 7
A 56 year old male presents with isolated right leg weakness of 1 hour onset. CT perfusion scanning reveals a small ischaemic volume of 10ml. There are no contraindications to thrombolysis however the location of the infarct contravenes mechanical thrombectomy with next generation devices. The patient is in a hospital with available neurosurgical HDU care. What is the best management plan?
(A) Proceed to thrombolysis as the patient is within the window
(B) Discharge the patient on optimal medical therapy as the ischaemic volume is too small
(C) Differ to specialist stroke physician opinion given that the evidence for thrombolysis of small strokes is currently controversial
(D) Admit to the stroke ward, initiate aspirin and clopidogrel, high dose statin and blood pressure control with ACE inhibition as tolerated
(E) Observe in EMU for 12 hours and if the symptoms resolve, discharge home with out patient follow up in one week.
C: Whether patients with mild clinical deficits benefit from intravenous tissue plasminogen activator (TPA) treatment after presentation with an acute ischemic stroke has been debated. In the case of radiologically mild stroke (CT perfusion volume <15 mL ischaemic core), TPA treated patients were significantly less likely to have excellent neurological outcome than untreated patients (relative risk, 0.83). Furthermore, even patients with a documented vascular occlusion on CTA did not have improved results with TPA. Also, 4.2% of TPA treated patients had evidence for haemorrhagic transformation. Ann Neurol 2016 Jun 28;
All of the following apart from which muscle is typically affected in saturday night palsy (compression of the radial nerve at the spiral groove) ?
(A) Supinator
(B) Extensor carpi ulnaris
(C) Triceps
(D) Brachoradialis
(E) Extensor pollicus longus
C: Whilst the triceps is innervated by the radial nerve, branches supplying it occur proximal to the spiral groove.
Question 2
What is TRUE regarding the posterior interosseous nerve?
(A) It is a deep branch of the radial nerve and is purely motor
(B) It is a superficial branch of the radial nerve and is purely sensory
(C) It is a branch of the median nerve
(D) It is a branch of the axillary nerve
(E) It is a branch of the ulnar nerve and is purely motor
A: The radial nerve branches into superficial and deep branches as it passes into the forearm. The superficial branch is sensory, affecting the skin around the anatomical snuffbox. The deep branch is purely motor, effecting the extensor compartment of the forearm and including the supinator
Question 3
Which of the following features reliably distinguishes posterior interosseous syndrome from radial nerve compression at the spiral groove on the humerus?
(A) Absence of sensory involvement
(B) Weakness in supination
(C) Weakness in finger extension
(D) Weakness in little finger abduction
(E) Weakness in finger flexion
A: The posterior interosseous nerve is a branch of the radial nerve, and is purely motor. It may be compressed as it passes underneath the supinator muscle (which it innervates). Finger extension is provided by extensor digitorum, extensor indicis, extensor digiti minimi. Wrist drop is characteristically absent, because extensor carpi radialis longus and brevis is supplied by the radial nerve prior to branching of the superficial and deep (posterior interosseous nn). The ulnar nn suplies little finger abduction, and finger flexion is provided by the median nn.
Question 4
Supination is provided by which of the following muscles and nn combination?
(A) Supinator and ulnar nn
(B) Biceps and musculocutaneous nn
(C) Brachoradialis and radial nn
(D) coracobrachialis and axillary nn
(E) Serratus anterior and long thoracic nn
B: The supinator is supplied by the posterior interosseous nn, which is the purely motor deep branch of the radial nn.
Question 5
The anterior interosseous nerve is a purely motor nerve. Which of the following is FALSE regarding its anatomy?
(A) It is a motor branch of the median nerve
(B) It branches in the forearm
(C) It supplies flexor pollicis brevis
(D) It supplies pronator quadratus
(E) It supplies flexor digitorum profundis I and II
C: This is supplied by another branch of the median nerve which passes deep to the flexor retinaculum. The anterior interosseous nn is purely motor, and it inervates pronator quadratus, flexor pollicis longus, flexor digitorum profondus I and II.
Question 6
Meralgia paresthetica is a syndrome involving the lateral cutaneous nerve of the thigh. Which of the following statements is FALSE
(A) It is a purely sensory branch of the lumbar-sacral plexus
(B) It is derived from L2, L3
(C) It passes close to the inguinal ligament
(D) It is characterised by numbness and tingling in the ventromedial aspect of the thigh
(E) It is associated with obesity
D: All the other statements are TRUE, however, the lateral cutaneous nerve of the thigh supplies sensation to the ventrolateral surface of the thigh.
Question 7
A 56 year old male presents with isolated right leg weakness of 1 hour onset. CT perfusion scanning reveals a small ischaemic volume of 10ml. There are no contraindications to thrombolysis however the location of the infarct contravenes mechanical thrombectomy with next generation devices. The patient is in a hospital with available neurosurgical HDU care. What is the best management plan?
(A) Proceed to thrombolysis as the patient is within the window
(B) Discharge the patient on optimal medical therapy as the ischaemic volume is too small
(C) Differ to specialist stroke physician opinion given that the evidence for thrombolysis of small strokes is currently controversial
(D) Admit to the stroke ward, initiate aspirin and clopidogrel, high dose statin and blood pressure control with ACE inhibition as tolerated
(E) Observe in EMU for 12 hours and if the symptoms resolve, discharge home with out patient follow up in one week.
C: Whether patients with mild clinical deficits benefit from intravenous tissue plasminogen activator (TPA) treatment after presentation with an acute ischemic stroke has been debated. In the case of radiologically mild stroke (CT perfusion volume <15 mL ischaemic core), TPA treated patients were significantly less likely to have excellent neurological outcome than untreated patients (relative risk, 0.83). Furthermore, even patients with a documented vascular occlusion on CTA did not have improved results with TPA. Also, 4.2% of TPA treated patients had evidence for haemorrhagic transformation. Ann Neurol 2016 Jun 28;
