📚 Question Bank

The UK refinement of Hanifin and Rajka criteria is used in the diagnosis of atopic dermatitis.

The above image is suggestive of infantile atopic eczema/dermatitis. It has a flexural distribution in adult type and extensor distribution in infantile type.

Clinical features include:

• Rash- erythematous, itchy papules/papulovesicles
• Excoriations
• Lichenified skin
• Dennie Morgan fold - under lower eyelid.
• Allergic shiners - periorbital pigmentation
• Allergic salute - horizontal groove on dorsum of nasal bridge.

The first site of involvement in infants with atopic eczema is the face. Atopic eczema can be divided into 3 phases:

• Infantile
• Childhood
• Adult

Infantile phase - Discrete or confluent oedematous papules associated with erythema. The papules are intensely itchy and may become exudative and crusted as a result of rubbing. Secondary infection and lymphadenopathy are common.

Childhood phase - starts at 18 to 24 months. Papules tend to be replaced by lichenification. The sides of the neck may show a striking reticulate pigmentation, sometimes referred to as atopic dirty neck.

Adult phase - Essentially similar to that in later childhood, with lichenification, especially of the flexures and hands.

Hertoghe's sign or Queen Anne's sign is defined as loss of lateral one third of eye-brows

(superciliary madarosis).

It is seen in various conditions such as:

• Hypothyroidism
• Lepromatous leprosy
• Atopic dermatitis
• Trichotillomania
• Alopecia areata

Option B: Anterior subcapsular cataract- shield-shaped cataract seen in atopic dermatitis. Option C: Transverse crease across the bridge of the nose- allergic salute.

Option D: Folds of skin under lower eyelids- Dennie-Morgan folds seen in atopic dermatitis.

The above image showing pustular lesions with heavy crusting in a patient with atopic dermatitis is suggestive of staphylococcal infection. Staphylococcus aureus is the most common organism to cause secondary infections in the lesions of atopic dermatitis.

However, human papillomavirusinduced warts, fungal infections, and viruses (such as HSV, vaccinia, coxsackie A, and the poxvirus of molluscum contagiosum) are also frequent pathogens.

The image shows flaky, white to yellowish greasy scales on the scalp, suggestive of infantile seborrheic dermatitis.

It is a common, inflammatory skin condition that causes the formation of flaky, white to yellowish greasy scales on oily areas such as the scalp, forehead, nose, or inside the ear. Cradle cap is the term used when it affects the scalp of infants.

It commonly appears around 3 months of age. It is rare after 8 months.

The above image shows a deepbrown pigmented lesion in the right underarm likely to have formed from the trickle of the droplets of perfume applied on the skin. This is suggestive

of Berloque dermatitis.

The skin pigmentation occurs due to an acute phototoxic reaction to perfumes containing bergamot oil (bergapten) which potentiates UVstimulated melanogenesis. A hot and

humid climate along with exposure to UV light increases the risk of developing this condition.

The given clinical scenario is suggestive of acute viral cerebellitis secondary to COVID-19. The true statement regarding the cerebellar circuitry is that that all climbing fibres originate from the contralateral inferior olivary nucleus.

Option A: Climbing and mossy fibers are excitatory and use glutamate and aspartate as the neurotransmitters.

Option B: Mossy fibers terminate on the granule cells forming glomeruli.

Option D: Efferents of the cerebellum pass through the superior and inferior cerebellar peduncles.

The middle cerebellar peduncle transmits fibers of pontocerebellar pathway.

The anterior spinocerebellar tract does not pass through the inferior cerebellar peduncle. It enters the cerebellum through the superior cerebellar peduncle.

Glioblastoma multiforme is the most malignant and frequently occurring type of primary astrocytomas. It has the worst long-term prognosis (median survival of roughly 1 year).

The pterygoid branch is not a branch of the cavernous part of the internal carotid artery. It is a branch of the petrous part.

Angiography reveals the characteristic finding of carotid siphon showing multiple bends and producing an S-shaped shadow. The image given below is a magnetic resonance angiogram showing the segments of internal carotid artery.

The basilar artery and the anterior spinal artery are unpaired arteries in the central nervous system.

The basilar artery is a single artery formed by the union of two vertebral arteries.

The anterior spinal artery is a single artery formed from a branch from each vertebral artery near its termination.

The labyrinthine artery is most commonly a branch of the anterior inferior cerebellar artery

(AICA). It can also be a direct branch of the basilar artery at times.

The basilar artery is formed by the union of two vertebral arteries. At the upper border of the pons, it divides into two posterior cerebral arteries.

The middle cerebral artery supplies the entire motor area except for the leg area. Thus, a lesion in the middle cerebral artery causes contralateral hemiparesis, sparing the leg area.

Anterior cerebral artery:

• It is the smaller terminal branch of the internal carotid artery.
• It runs in the sagittal fissure and anastomoses with the posterior cerebral artery.
• It supplies the medial surface of the cerebral cortex and parts of lentiform, caudate nuclei and the internal capsule.

Middle cerebral artery:

• It is the larger terminal branch of the internal carotid artery.
• It runs in the lateral sulcus.
• It supplies the entire lateral surface of the cerebral hemisphere except for a narrow strip
• (supplied by the anterior cerebral artery) and the occipital pole and the inferolateral surface
• (supplied by the posterior cerebral artery).

Posterior cerebral artery:

• It is the terminal branch of the basilar artery.
• It supplies the occipital lobe, inferolateral and medial surfaces of the temporal lobe, and parts
• of the brainstem.

The chief artery of the superolateral surface of the cerebral hemisphere is the middle cerebral artery.

Both the anterior and middle cerebral artery supply the superolateral surface of the brain but anterior cerebral artery supplies only a narrow strip at the upper superolateral surface rest is supplied by the middle cerebral artery. Therefore, the chief artery is the middle cerebral artery.

The chief artery of the medial surface of the brain is an anterior cerebral artery. The chief artery of the inferior surface of the brain is the posterior cerebral artery. Lateral cerebral artery is not an artery.

The given clinical scenario is suggestive of Wallenberg's syndrome (lateral medullary syndrome) and the marked vessel is the vertebral artery. The largest branch of this artery is the posterior inferior cerebellar artery.

The vertebral artery is a branch of the first part of the subclavian artery. It enters the skull through the foramen magnum and terminates by joining the vertebral artery of the opposite side forming the basilar artery. The branches of the cranial portion of the vertebral artery are:

• Meningeal branches - supplying dura of posterior cranial fossa
• Posterior spinal arteries - supply posterior one-third of the spinal cord
• Anterior spinal artery - supply anterior two-thirds of the spinal cord
• Posterior inferior cerebellar artery - supplies the lateral part of the medulla, cerebellar hemisphere, and the choroid plexus of the fourth ventricle.
• Medullary branches - supplying the medulla

The image given below shows the vertebral artery.

The marked structure is medulla oblongata. The superior cerebellar artery does not supply the medulla oblongata.

The marked structure is fornix which is supplied by the anterior cerebral artery.

The anteromedial central branches from the anterior cerebral artery supply the fornix along with optic chiasma, lamina terminalis, hypothalamus, para-olfactory areas, and cingulate gyrus.

The marked structure is the posterior limb of the internal capsule and the recurrent artery of Heubner is not a part of its blood supply.

The posterior limb of internal capsule is supplied by:

• Charcot's artery (branch of middle cerebral artery)
• Anterior choroidal artery (branch of internal carotid artery)
• Posterolateral branches of posterior cerebral artery.

Posterior communicating artery does not supply the putamen.

The superficial middle cerebral vein drains into the cavernous sinus.

Superficial middle cerebral vein lies in the lateral sulcus and drains most of the lateral surface of the hemispheres. It drains into the cavernous sinus.

Superficial middle cerebral vein is connected to the superior sagittal sinus through the superior anastomotic vein of Trolord and to the transverse sinus through the inferior anastomotic vein of Labbe.

Two internal cerebral veins join to form the great cerebral vein of Galen beneath the splenium of the corpus callosum. It receives the basal veins and drains into the straight sinus.

The great cerebral vein of Galen drains into the straight sinus.

The image given below shows the venous drainage of cerebral veins.

Filum terminale extends up to the 1st coccygeal vertebra. It is a filament of connective tissue descending from the apex of conus medullaris.

Ligamentum denticulatum is not a modification of arachnoid mater. It is a modification of the pia mater.

The ligamentum denticulatum is a flat fibrous sheet on either side of the spinal cord present between the ventral and dorsal spinal roots. It serves as a neurosurgical landmark for hemisectioning of the spinal cord.

Its medial border is continuous with the subpial connective tissue. Its lateral border forms a series of 21 triangular processes on each side connecting it to the dura mater giving it a serrated appearance.