NEB Step-1 Formative Assessment-SEQ

1. NEB Formative Assessment
Gait, Skeletal Supports & Locomotion
Prof. Saeed Shafi
SMC/SFLT
During a military drill in PMA Kakool, an army cadet got his medial
aspect of the sole injured by a barbwire which resulted in
excruciating pain on medial aspect of foot extending to the leg and
lower thigh. A week later he developed painful enlarged lymph
nodes in the groin.
(A) Give drainage area of inguinal lymph nodes.
(5)
(B) Draw & label cutaneous nerve supply of sole of foot.
(5)

2. Saleem Khan, chukidar of Boy’s Hostel of SMC
got bullet injury of left femoral sheath. He was
brought immediately to CMH Emergency, where
Vascular surgeon ligated both ends of his
damaged femoral artery. His postoperative
recovery was smooth.
A. Enumerate alternate source/s of arterial
supply to lower limb in this case. (5)
B.Illustrate the compartments and contents of
femoral sheath. (5)

3. A football player while kicking the football
twisted his right leg at right angle to convert the
ball into goal. He fell down and was unable to
flex his fully extended knee.
A. Name the movements taking place at
knee joint and muscles responsible for
each movement. (6)
B.Which muscle initiate unlocking
mechanism in a fully extended knee and
how? (4)

4. Mallala, a young university student presented in
SSMC with difficulty in running and jogging. She
was rejected from PAF on medical grounds.
After thorough work-up her physician declared
that her problem is due to flat feet.
A. Enumerate structures/ factors
responsible for formation and
maintenance of medial longitudinal arch
of foot. (6)
B.Draw & label cutaneous nerve supply of
dorsum of foot. (4)

5. Eiman, a 2nd year medical student of Poonch
Medical University is expecting her menstrual
bleeding from 8th March, 2013. All of her family
members are planning a week long trip to Saudi
Arabia to perform Umrah in 2nd week of March,
2013. Her mother and sister compelled her to
accompany the family to Mecca to perform
Umrah. She visits you (being the family
Physician) to get medical and/or religious
advice to delay her menstrual bleeding.
A. Is this possible in our religious and social
context? What medical advice you can offer
Eiman, enabling her to perform Umrah with
her family during these days? 6
B.What is corpus luteum? Give its formation and
function/s. 4

6. An elderly woman with osteoporosis is taken to
emergency department following a fall in
washroom. One of her legs appeared shortened
and externally rotated. Radiological
examination of affected hip revealed fracture of
neck of femur. The Consultant Orthopedic
Surgeon advised her hip prosthesis.
A. What is the anatomico-physiological basis of
her presentation? (4)
B.Enumerate extensors of hip, along with their
nerve supply. (6)

7. During change of Command parade at Army
stadium Rawalpindi, an army cadet fell down
and fractured his medial epicondyle of left
humerus. A week later he developed claw hand.
A. What is the anatomical basis of claw-hand
in such cases? (4)
B.Draw & label cubital fossa and give its
contents. (6)

8. Khansa Gull, a tall, slim fashion model, noticed
a midline dimple and a tuft of hair at
lumbosacral junction of her spine. X-ray lumbo-
sacral spine revealed incomplete vertebral arch
and absence of spinous process of L4 & L5
Vertebrae.
A. What is the embryological basis of Khansa’s
presentation? (6)
B.What future complications may happen in
such cases? (4)

9. During Skill Lab session, Faryal, a 2nd year
medical student of SMC was given the task to
inject intravenous injection to a classfellow in
cubital fossa.
A. Enumerate the boundaries and contents
of cubital fossa. (6)
B.Give the attachment and function of
bicipital aponeurosis and tendon. (4)

10. Ammal, a 45-year unmarried City School
teacher developed carcinoma in upper & outer
quadrant of her right breast. She underwent
radical mastectomy with ipsilateral clearance
of axillary lymph nodes. Her postoperative
convalescence was trouble free. Four weeks
later, she reported in surgical OPD with inability
to raise her right arm vertically upward. The
examining physician asked Ammal to press his
hands against the wall in front. It was found that
the medial border and inferior angle of his right
scapula became prominent.
A. What is the neuroanatomic basis of her
clinical presentation? (4)
B.Enumerate boundaries and contents of axilla.
(6)

11. Ismat, a 1st year medical student of RMC,
Rawalpindi, developed atrophy of right thenar
eminence a months after mid-shaft fracture of
her radius in a road traffic accident at Kohala
bridge. She can perceive general sensations
over thenar eminence and perform adduction
of thumb; whereas, all other movements of
thumb are absent.
(A) What is the neuroanatomic basis of her
presentation? (4)
(B) Draw and label the cutaneous nerve supply
of hand. (6)

12. Faiza Kiran, a grade 9 student of AAA high
school Muzaffarabad fell from bicycle and got
fracture of surgical neck of right humerus. Her
arm was immobilized by a PAHALWAN for 4-
weeks. Later on, she was unable to perform
abduction of affected shoulder and had sensory
loss on its overlying skin.
A. What is the neuro-anatomical basis of her
presentation? (5)
B.Enlist the abductors of shoulder along with
their nerve supply. (5)

13. Saady, a 55-year old Pakistan Railway Qully,
whose work involved carrying heavy loads on
the shoulder, experienced difficulty in raising his
right arm vertically upward after lifting a large
suit-case at Rawalpindi Station. The examining
physician asked Amman to press his hands
against the wall in front. It was found that the
medial border and inferior angle of his right
scapula became prominent.
A. What is the neuroanatomic basis of his
presentation? (6)
B.Define axilla. Give its contents. (4)

14. Shakeel, a left handed A.C. technician was
fixing a split air conditioning unit in the wall.
While fixing screws he attempted many times to
tighten screws with his left hand but ultimately
he has to use his right hand to accomplish the
task.
A. What movement of Shakeel’s upper limb
is essential for mannual tightening of
screws? (3)
B.Which joint/s participate in such movement.
(3)
C. Why Shakeel ultimately used his right
hand for this action, whereas, he was a left
handed guy? (4)

15. Turbat khan, a short stature Chukidar of PC
Muzaffargarh developed abnormal backward
bulging of his dorsal spine during school-age.
A. Compare primary and secondary curvatures
of vertebral column. (6)
B.Enumerate parts of a typical vertebra. (4)

16. Ronaldo, a famous football player while kicking
the football twisted his right leg, which resulted
in excruciating pain in the right knee joint and
spasm of ipsilateral hamstrings. Moreover, he
was unable to extend his affected knee.
A. Which structure of the knee joint is most
liable to injury in this case and why? (5)
B.Which muscle initiate unlocking mechanism
in a fully extended knee and how?
(5)

17. After a major abdominal operation, a patient
was given a course of antibiotics by
intramuscular injections. The nurse was
instructed to give the injections into the right
buttock. After leaving hospital, patient felt
impaired skin sensation on the lateral side of the
right leg.
a) Give neuro-anatomic basis of impaired
sensation in this case.
5
b) Name two safe sites for intramuscular
injections in human body and justify it.
5

18. A 38-year-old woman presented with
complaints of headache, high-grade fever,
neck stiffness, nausea, and vomiting. The
neurologic examination revealed intact cranial
nerves, normal reflexes, and no sensory or
motor deficits. Her white blood cell count was
21,800/mm3 with 67% polymorphonuclear
leukocytes and 26% band cells. A lumbar
puncture was suggested by her physician. Using
your knowledge of Basic Medical Sciences:
a. Name the structures (from superficial to
deep) pierced by the needle during lumbar
puncture. 6
b. What are the different abnormal curves of
vertebral column?
4

19. Misry Khan, a retired military personal got bullet
injury of left femoral artery in femoral sheath.
He was brought immediately to Emergency,
where Surgeon ligated both ends of his
damaged femoral artery. His postoperative
recovery was smooth.
a. Enumerate alternate source/s of arterial
supply to lower limb in this case.
6
b. Enumerate clinical applications of femoral
artery. 4

20. a. Draw and label the compartments and
contents of femoral sheath. (6)
b. Enlist the components of Quadriceps
femoris muscles along with their nerve
supply and action/s. (4)

21. a. Illustrate the cutaneous nerve supply of
dorsum of foot. (4)
b. Enlist muscles of flexor compartment of
leg giving their nerve supply and action/s of
each. (6)

22. Noor Afshan brought her one year old boy to
pediatrician for deformed foot. After a
thorough work up, pediatrician diagnosed him
a case of talipes equinovarus/club foot.
a. Name two characteristic features of club
foot. 4
b. Enlist structures (from medial to lateral)
passing deep to flexor retinaculum of foot. 6

23. a. Enumerate Hamstring muscles along with
their nerve supply and action/s. 5
b. Enlist veins commonly used for venae
puncture in lower limb; and why? 5

24. A 50 year old lady presented with drooping of
eyelids. She is unable to raise her hands above
her head. After investigation the doctor finds
that it is some autoimmune disorder of
neuromuscular junction.
(A) Explain the physiological mechanism
responsible for her presentation.
4
(B) Draw and label neuromuscular junction in
skeletal muscle.
6

25. A 15 yrs football player was hit by another
player’s helmet, striking into his axilla. On
getting up, he complained of shoulder
weakness and pain. He was taken to the ER of
AIMS, Muzaffarabad. On examination, he has
ability to initiate shoulder abduction, but he
cannot raise his arm more than 15 degree.
There was mild weakness of lateral rotation and
a patch of sensory loss over his affected upper
arm.
a. Enlist muscles responsible for abduction at
shoulder joint. 5
b. Why he cannot raise his arm more than 15
degrees? 5

26. A 38-years aged School teacher was travelling
from Kohala to Bahg. She placed her hands on
the dashboard immediately prior to accident.
She complained of diffuse pain and weakness
in her upper limbs. Clinical examination showed
bilateral wrist drop. X-ray examination revealed
bilateral fracture of the humerus at the spiral
groove.
a) What is the neuro-anatomic basis of wrist
drop in her case? 5
b) Which blood vessel/s in spiral groove is
liable to injury in her case and why? 5

27. Nazia, a 22-year old embroider from Shangla
came to her family physician complaining of
difficulty in creating patterns on cloth because
she was unable to hold a needle between her
thumb and index finger. She was awakened
from sleep at 3:00 am due to pain and tingling
sensation in her right hand. Examination
revealed decreased sensations in her thumb,
index and middle finger; and wasting of
muscles of thenar eminence.
a. Give anatomico-physiological basis of her
presentation. 6
b. Which nerve is most likely to be involved in
her case? 4

28. Faria, a grade seven, City School student got
fracture of left arm, while climbing to
PirChinassy mountain. She was brought to
AIMS-Muzaaffarabad by Rescue workers. After
thorough clinical examination, Resident Doctor
told her mother that she had wrist drop of left
hand. X-ray of left arm confirmed mid-shaft
fracture of Humerus.
a. Injury to which nerve is responsible for
her presentation and why? (5)
b. What is the neuroanatomic basis of wrist
drop in such cases? (5)

29. Rafia, a 45-year aged business executive of
Telenor presented in orthopedic OPD of CMH
Sakadu with complaints of painful movements
of right shoulder during brushing hair, changing
clothes and brushing her teeth. The symptoms
worsened over the period of four months. The
orthopedic surgeon after thorough workup
diagnosed her as a case of “rotator cuff
syndrome”.
a. Enlist structures contributing to the
formation of rotator cuff. (5)
b. Which muscle/s are responsible for
abduction of shoulder joint? (5)

30. Abdullah, a 12-year old school boy got fracture
of medial epicondyle of right humerus, while
playing football. On examination, he had
sensory loss involving the little finger and medial
aspect of the ring finger. He was unable to
abduct and adduct the fingers at
Metacarpophalangeal joints.
a. Which nerve is involved in this case and
why? (6)
b. If this injury is neglected, what will be the
resultant deformity? (4)

31. Talat, a middle aged school teacher came to
medical OPD with complaints of pain along the
medial side of her right forearm along with
parasthesia of hand. She also complained of
ischemic pain in hand on excessive use. On
thorough workup she was diagnosed as a case
of cervical rib.
a. Which cord of brachial plexus is most likely
to be affected by cervical rib and why? 4
b. Why Talat felt ischemic pain on excessive
use of her right hand? 6

32. Rukhsana, a 1st year nursing student, developed
atrophy of left thenar eminence two months
after mid-shaft fracture of her left radius in road
traffic accident. She can perceive general
sensations over that area.
a. What is the neuro-anatomic basis of her
presentation? 4
b. Draw and label the cutaneous nerve supply
of hand. 6

33. Amman, a 35-year old professional labourer,
whose work involved carrying heavy loads on
the shoulder, experienced difficulty in raising his
right arm vertically upward. The examining
physician asked Amman to press his hands
against the wall in front. It was found that the
medial border and inferior angle of his right
scapula became prominent.
a. Is this a problem of nerve injury, muscle
injury, both OR something else? 4
b. What is the neuroanatomic basis of his
clinical presentation? 4
c. What would be your priority for diagnosis of
such patient? 2