14- Pre operative Fawzia MSQs Only Flashcards
1
Q
1- A 37-year-old man presents with severe headache, photophobia arid neck stiffness. Karnig’s sign is positive and a midline lumbar puncture is performed immediately to determine if a cerebrospinal fluid (CSF) pathogen is involved. In performing this procedure, which is ‘he first of the following structures to be pierced by the lumbar puncture needle?
A
Interspinous ligament
in Order from skin to inward skin
supraspinus ligament
interspinus ligament
ligamentum flavum
2
Q
2- 11. A 70-year-old woman from a nursing home presents to the! Emergency Department with abdominal pain and vomiting. On examination, she is dehydrated and her abdomen is distended. There is a 3 cm 4 cm swelling in her right groin which is non-tender, and there is no cough impulse. At operation, a femoral Hernia found. Which of the following lies medial to the neck of the hernia?
A
Lacunar ligament
3
Q
3- 12. A 26-year-old man presents to the Emergency Department with extensive bleeding from his arm after sustaining a glass injury. On examination there is a 7 cm transverse laceration across the anterior aspect of his elbow. On exploring the cubital fossa you would expect the brachial artery to be:
A
lateral to the median nerve
4
Q
4- 15. A 45-year-old mart presents with backache and leg pain due to a prolapsed lumbar Intervertebral disc. The pain, which is aggravated by coughing and sneezing, radiates to the lateral aspect of the foot. On examination, there is weakness of the plantar flexors of the foot, which nerve root is most likely to be involved?
A
S1
5
Q
5- A 22-year-old man has been stabbed in the left fifth intercostal space at the edge of the sternum. Which structure is most likely to have been penetrated?
A
Right ventricle
6
Q
6- 19. An 80-year-old man dislocates his shoulder it is reduced in the Emergency Department. At review three weeks later, he is unable to actively initiate abduction of his arm. Which muscle most likely damaged?
A
Supraspinatus
initiation up to 15 = supraspinatus
15-90 = deltoid
90 and above = trapezius + seratous anterior
7
Q
7- 24. A 42-year-old multiparous woman is admitted to the Emergency Department due to pelvic discomfort. The duty gynecologist diagnoses uterine prolapse. Which anatomical structure gives significant direct support to the uterus?
A
Transverse perinea! Muscles
8
Q
8- 29. Which one of me following muscles is an extensor of the hip?
A
Semitendinosus
9
Q
9- 31. A 65-year-old man presents with haematuria and left loin pain. Computerised tomography demonstrates a left renal tumour. He undergoes a left radical nephrectomy. Where does the left renal artery lie?
A
Posterior to the left renal vein
remember it croses in front of the aorta and below SMA
10
Q
10- 32. Within the posterior triangle, which nerve is at particular risk of damage during surgery?
A
Spinal accessory
11
Q
11- 33. The right and left pulmonary arteries are derived from which of the following embryological aortic arches?
A
Sixth aortic arch
12
Q
12- 35. During arch aortography, the vertebral artery would be seen to arise directly from which of the following?
A
Subclavian artery
13
Q
13- 35. During arch aortography, the vertebral artery would be seen to arise directly from which of the following?
A
Subclavian artery
Subclavian artery is a little bit important, why ?
Because it Supplies :
Thyroid
Breast
Diaphragm
Brain stem
And upper limb
14
Q
14- 37. A 3-year-old boy is admitted to hospital with severe vomiting. Radiographic examination reveals that he is suffering from annular pancreas. Which of these structures is constricted?
A
Second part of duodenum
15
Q
16- 43. A surgeon makes a Pfannenstiel incision for access to the pelvic organs. He incises theabdominal wall down to and through the rectus sheath .- He retracts the rectus abdominis muscles laterally from the midline to expose the:
A
transversalis fascia
16
Q
15- 39. A 36-year-old man presents with a two-month history of low back pain radiating to his left leg After clinical examination he is referred for an MRI scan. This shows a prolapsed intervertebral disc. The clinical signs are consistent with pressure on SI roots. Which combination of clinical signs is most likely?
A
Weak ankle plantarfiexion; altered sensation on the sole of the foot; loss of ankle jerk reflex.
The Trick here is to look for Ankle Reflex loss and sensory loss of s1 root = lateral foot & sole
17
Q
17- 49. A 65-year-old man presents with vomiting and .weight loss. On examination he had 3 palpable epigastric mass. The transpyloric plane lies at which; vertebral level?
A
L1
L1 =
Pylorus
Neck of pancreaus
SMA
Gall bladder fundus
kidney hilum
2nd part of dudenum
dudenojujenal flexure
transverse colon
End of spinal cord
18
Q
18- 51. In an emergency situation what is the most appropriate surgical method of obtaining an airway?
A
Piercing the cricothyroid membrane
cricothyrodotomy
19
Q
19- 52. A 75-year-old man presents with hepatomegaly and ascites. Computerised tomography shows evidence of post hepatic portal hypertension. The inferior vena cava passes through the Diaphragm at which vertebral level?
A
T8
IVC T8 - bifuraction T5
esophagus 4 constrictions diaphragm T10
Aorta T12 bifurcation T4
19
Q
20- 62. A 2-year-old child is referred because of an impalpable testis in the left scrotum. Which of the following positions describes an ectopic testis?
A
At the root of the penis
19
Q
21- 65. An 82-year-old man has complete occlusion of his inferior mesenteric artery on angiography but no symptoms or signs of colonic ischemia. Which of the following arteries is the most likely additional source of blood supply to the territory of the inferior mesenteric artery?
A
Middle colic
20
Q
22- 69. A 35-year-old man is admitted to hospital with vomiting, nausea and severe headaches. An MRI scan reveals a tumour of the cerebellopontine angle. Which one of the following pairs of cranial nerves is most likely to be compressed by this tumour?
A
Facial and vestibulocochlear
2244
cerebral 2 (1,2 )
midbrain 2 (3,4)
pons 4 ( 5,6,7,8 )
medulla 4 ( 9,10,11,12 )
21
Q
23- 70. After resection of d rectal tumour a patient experiences erectile dysfunction. Which of the following nerves is most likely to have been damaged in surgery?
A
Pelvic splanchnic nerves
Nervi ergintis
22
Q
24- 72. A 22-year-old man arrives to the Emergency Department with sudden breath less ness due to a large pneumothorax. A chest drain is inserted into the fifth left intercostal space in 5th mid-axillary line. There is haemorrhape into the drainage bottle. Which of the following structures is the most likely cause of this acute haemorrhage?
A
Intercostal artery
23
25- 76. In order to expose the right axillary artery, a transverse skin incision is typically made below the clavicle from a point just lateral to the sternal end of the clavicle to the deltopectoral groove. Which of the following structures would be encountered in the dissection down to the vessel?
Thoraco-acromial artery
24
26- 77. A 4-year-old boy presents to the Emergency Department with a two-day history of headache vomiting and drowsiness. A CT scan reveals dilatation of both his lateral ventricles and his third cerebral ventricle. His fourth ventricle was of normal size. It is suspected that he has an obstruction to his cerebrospinal fluid flow. At which of the following sites is the obstruction most likely to be?
Cerebral aqueduct (of Sylvius)
25
27- 80. A 56-year-old man with chronic emphysema is on the high dependency unit (HDU), ten days after anterior resection. He has developed acute shortness of breath' and hypotension): Which of the following landmarks would be the most appropriate to use to obtain a femoral arterial blood gas sample?
A point midway between the anterior superior iliac-spine and the' pubic symphysis
26
28- 81. A 70-year-old man complains of persistent numbness since.an inguinal hernia repair one year previously. The numbness affects the top of the scrotum, root of penis, and a small area below the medial part of the inguinal ligament. Which nerve is likely to have been damaged?
llioinguinal nerve
27
29- 82. A 12-year-old girl has a diastolic murmur. It is maximally audible in the second left intercostal space. Pathology of which structure is the most likely cause?
Pulmonary valve
28
30- 87. A 60-year-old man undergoes cystectomy for a bladder carcinoma. During surgery, the ureters are identified. On which region of the bladder do the ureters pierce the bladder wall?
Posterior surface
A very famous Recall Anatomy Question yet does come with many answsers
if you found Base in the options choose it
if not go for posterior like here
29
31- 88. A year-old patient in the intensive care unit has a tracheostomy performed via the second, third and fourth tracheal rings. Which intervening structure is most likely to require transection?
Thyroid isthmus
30
32- 89. A 23-year old man is assaulted and sustains a stabbing injury to the left groin. The wound- is cleaned and a simple dressing applied; Six months later the patient returns with pulsatile swelling at the site of the injury. The most probable lesion present is:
False aneurysm of the femoral artery
31
33- 91. A 16-year-old boy is hit on the left side of the face by a ball. There are no broken bones but the boy complains of numbness of the face below the eye. Which nerve has most likely been compromised?
infra-orbital nerve
32
34- 94. After receiving an intermascular Injection in the buttock, a 25 year-old man complains of inability to evert his foot Which nerve is most likely to have been injured?
Common peroneal (fibular) component of sciatic
Evertion of the foot is specifically the lateral compartment action ( Pernoneus Longus & brevis ) via superficial peroneal nerve
33
35- 98. A 36-year-old man falls on his outstretched right hand. Examination reveals tenderness in the anatomical snuff box. Which one of the following tendons form a boundary of the anatomical snuff box?
Extensor pollicis longus
.........................
Forms medial boundry of the snuff box
34
36- 122. A 55-year-old man presents with back ache. Neurological examination reveals lack of extension of the left great toe .; Which of the following spinal cord segments are likely to be involved?
L4, L5 & S1
35
37- 103. A 34-year-old man is seen in the Emergency Department with a fibular fracture following football match. On examination he is noted to have loss of foot eversion. Which area of skin should be examined to confirm. loss of the cutaneous distribution of the affected-nerve?
Cross the dorsal surface of the foot
it's the anterior part which you can see with your eye
when you look at it
yes it's not the sole :)
36
38- 110. A 10-year-old child presents with progressive facial weakness and a squint. On examination there is a lower motor neuron facial weakness and failure of abduction of one eye. An MRI scan shows a small, intrinsic mass lesion within the central nervous system. Where is this most likely to be located?
The pons
2244
Cerebrum 2
mid brain 2
pons 4
medulla 4
37
39- 116. A 50-year-old man complains of recent onset diplopia. On examination he is unable to lookinwards and downwards with his right eye; The most likely diagnosis is a lesion of the?
trochlear nerve
38
40- 127. A 66-year-old woman with known tumour of her spine has started to retain urine and is experiencing decreased anal and rectal tone. The tumour is pressing directly on the conus medullaris. At which one of the following vertebral levels is the tumour most likely to be located?
L1/L2
39
43- 135. A 35-year-old man presents with a three-week history of low back pain and a three- day history of pain and weakness in his left leg. Physical examination demonstrates numbness over the posterior aspect of the left calf extending to the lateral aspect of the foot. Left ankle reflex is absent. A magnetic resonance scan shows compression of the left S1 nerve root. What is the most likely responsible structure?
Nucleus pulposus
39
41- 129. A 50-year-old woman presents with a history of faecal incontinence over the past few year She had a prolonged and difficult first stage of labor 20 years previously. Physical examination reveals a relatively lax anal sphincter. Which nerve is likely to have been damaged in labour?
Pudendal nerve
remember it's responsible for incontence but not
erection which was nervi ergintis splanchnic nerves
39
46- 13. A 65-year-old man has a history of transient ischemic attacks. He is due to undergo carotid endarterectomy. Which one of the following is true of the internal carotid artery?
A. Begins at the level of the sixth cervical vertebra
B. Divides into the anterior, middle and posterior cerebral arteries
C. Gives off the ophthalmic artery(Right)
D. Is accompanied within the skull by preganglionic sympathetic nerves
E. Passes through the foramen ovale
........................................................................
Ophthalmic artery :
Begins at C3 when CCA bifurcates enters through carotid canal in forumen lacerum ends in the circle of willis separated from external carotid by styloid process
Branches :
1. Ophthalmic artery
2. Ant & Middle cerebral arteries
3. Posterior communicating & Anterior Choroid arteries
40
42- 134. A 4-year-old boy, is brought to the Emergency Department with a painful right elbow. His father stales that he was swinging his son by his arms when the pain came on suddenly An X-ray shows that the radial head is displaced from its usual position. What is the ligament (of the proximal radio-ulnar joint) that holds the radial head in place?
Annular ligament
41
45- 12. A 34-year-oid man is admitted to-the Emergency Department with a head injury. On examination his Glasgow coma scale is 9. A CT scan of the brain demonstrates an extra dural haemorrhage. Which of the following arteries is the most likely source of this?
Middle meningeal
Very common recall Question
it's branch from maxillary artery which is from the external carotid not the internal carotid
41
44- 5. A 32-years old man presents with a painful torticollis there is no past medical history and his only complaint is that he has been feeling rather tired over the last 4 nights. On examination, he has large rubbery mass in the lateral aspect of his neck as well as a few smaller masses along his internal jugular vein. You correctly assume that the muscular neck spasm and the large mass are connected. The most likely cause of his torticollis is due to pressure on?
Spinal accessory nerve
nerve supply of Trapezius & Sternomastoid
42
48- 16. A 55-year-old man presents with acute back pain following a severe road traffic accident. Neurological examination reveals lack of sensation of the umbilicus and below. What is the spinal level of the neurological deficit likely to be?
T10
43
50- 20. A 75-year-old man presents with esophageal reflux. Endoscopy confirms the Presence of a hiatus hernia. The esophagus passes through the diaphragm at which level?
T10
T8 = IVC + Right Pherenic nerve
T10 = esophagus + Both Vagii
T12 = Aorta + azygous + thoracic duct
43
47- 15. A 26-year-oJd man presents to the Emergency Department after sustaining a glass cut to his arm. On examination there is a 10 cm longitudinal laceration on the anterior aspect of his upper arm. He has symptoms suggestive of ulnar nerve injury.
On exploring the upper part of the arm we would expect the ulnar nerve to be:
medial to the brachial artery
44
49- 19. A 60-year»old man presents to the-Emergency Department with epistaxis. The source of the bleeding is identified as Little's area and resolves with direct cautery. Which vessel is most likely responsible for the bleeding?
Sphenopalatine artery
Kiesselbach's area, or Kiesselbach's triangle.
The arteries are: 4
Anterior ethmoidal artery (branch of the ophthalmic artery)
Sphenopalatine artery (terminal branch of the maxillary artery)
Greater palatine artery (from the maxillary artery)
Septal branch of the superior labial artery (from the facial artery)
45
51- 22, A 26-year-old man is having a stereotactic frame fitted to his skull prior to radiosurgery on a cerebral arteriovenous malformation. Four pins secure the frame tightly through the scalp to the outer table of the skull, two anteriorly, two posteriorly. On insertion of one of the-posterior pins, arterial haemorrhage is encountered. Which artery is most likely to have been punctured?
The occipital artery
46
53- 28. A 45-year-old man presented with backache and leg pain due to -prolapsed lumbar . intervertebral' disc. The pain, which is aggravated by coughing and sneezing; radiates to the dorsum of the foot On examination there is weakness, of the dorsiflexion of the foot. Which nerve root is most likely to be involved?
L5
47
52- 24. A 2 day old baby presents with increasing respiratory distress. He was born at term By normal vaginal delivery. On examination he has cyanosis of the lower limbs and marked respiratory in drawing of the chest His femoral pulses ate absent bilaterally and he has been anuric for the last 2 hours. Pulse rate is 140 beats/minute, regular, and his blood pressure is 60/30 mmhg in both upper limbs. What is the most likely diagnosis?
Interrupted aortic arch
Tetralogy of Fallot (TOF) is a congenital heart defect with four components:
1) large ventricular septal defect (VSD), which is a hole between the two ventricles or pumping chambers in the heart;
2) pulmonary stenosis, which is narrowing beneath or in the blood vessel leading to the lungs;
3) overriding of the aorta, in which the aorta lies directly above the ventricular septal defect; and
4) as a result of these events, the right ventricle becomes thickened or hypertrophied.
48
56- 32. A 19-year-old woman presents to the Emergency .Department profoundly hypovolemic having fallen from a horse. A postero-anterior (PA) chest radiograph shows a fracture to the medial third of the left clavicle. Which of the following vessels was-most likely damaged?
Left subclavian artery
49
54- 29. A 75-year-old woman, who has a carcinoma of the upper rectum, undergoes anterior resection. The arterial blood supply of the upper rectum arises from which of the following?
Inferior mesenteric artery
The rectum receives arterial supply through three main arteries: Superior rectal artery - terminal continuation of the inferior mesenteric artery. Middle rectal artery - branch of the internal iliac artery. Inferior rectal artery - branch of the internal pudendal artery.
50
55- 30. A 65-year-old man is undergoing an abdominal aortogram, A stenosis is demonstrated in a lateral aortic branch, arising at the level of the body of the second lumbar vertebra. The stenosed vessel is most likely to be the:
second left lumbar artery
T12 = Celiac +inf phrenic + 1st lumbar
L1 = Superior mesenteric + Renals L1/L2
there is a controsversry around this Q
L2 = 2nd Lumbar + gonadal arteries
L3 = IMA
L4= bifurcates
51
58- 35. A 28-year-old man presents with pain in his left scrotum. A diagnosis of varicocele is made. Which vessel is involved?
Testicular vein
any young patient with varicocele do us to exclude RCC occluding the renal vein Fingers Like Projections
51
57- 33. 65 years old man presented with an inguino-scrotal swelling in the right groin which is non tender. A cough impulses is elicited, At operation, an indirect inguinal hernia is repaired. The cremasteric muscle is derived from which of the following
Internal oblique muscle
52
59- 38. 65-year-old man presents with a non-tender swelling in the right hemi-scrotum. At operation, the hydrocele sac is opened and 400 ml of fluid is drained. Which anatomical structure surrounds the fluid?
Tunica vaginalis
Processus vaginalis in conginital hernia / hydrocele as a continuity of the peritonium but an old man definitly in tunica vaginalis the hydrocele will accumulate
52
60- 39. A 24 years old man is brought to the Emergency Department following a road traffic accident. He has obvious airway compromise due to mouth/ facial haemorrhage which requires a surgical airway. The surface landmarks used to localise, the optimal site for a tracheostomy incision are midway between the suprasternal notch and which of the following?
Cricoid
in tracheostomy we do cut the thyroid Isthmus
( very common recall )
52
61- 41. A 20-years man presents to the Emergency Department after accidentally tripping over and lacerating his hand on a glass bottle. On examination there is a 2 cm laceration on the hypothenar eminence with loss of flexion in the distal interphalangeal joint of the little finger. What is the most likely tendon to be injured?
Flexor digitorum profundus
Take care is he asking about Distal or Proimal Don't slip
in this Trap
Proximal by Superficial
Distal by Profundus
53
62- 42 A 75-year-old man, who smokes heavily, underwent coronary artery bypass grafting six months ago. A left internal-mammary artery graft was used. He now complains of angina on pegging his laundry on the washing line to dry. Which of the following lesions best explains his symptoms?
Stenosis of the subclavian artery proximal to the first branch
54
63- 45. A 50-year-old alcoholic man presents-to the Emergency Department and is found to be unable to extend his wrist, thumb and fingers of his right hand. He is also found to have weak extension of the right elbow joint and loss of sensation on the dorsum of the first web space. Which nerve is most likely to have been injured?
Radial nerve
55
65- 46. A 21-year-old man has been stabbed in the back of the knee, dividing the popliteal artery, and is undergoing repair via a posterior approach. Which of the following structures is most likely to be encountered first, when dissecting deep from the skin , incision?
Tibial nerve
55
64- 44. A 55 year-old man presents with acute back pain following a severe road traffic accident. Neurological examination reveals lack of dorsi-flexion of the left ankle joint. Which of the following spinal cord, segments are most likely to be injured?
L4, L5 & S1
Femoral & Obturator : L2,3,4
Pudendal : S2,3,4
Sciatic & Tibial : L4,5,S1,2,3
Common Peroneal: L4,5,S1,2
Superficial Peroneal : L4,5,S1
Deep Peroneal : L4,L5
56
66- 47. A 78-year-old woman presents with urinary urgency and incontinence. The external urethral sphincter is innervated by which of the following nerve roots?
S2.3& 4
Femoral & Obturator : L2,3,4
Pudendal : S2,3,4
Sciatic & Tibial : L4,5,1,2,3
Common Peroneal: L4,5,S1,2
Superficial fibular : L4,5,S1
Deep Fibular : L4,L5
57
67- 49. A 19-year-old man was assaulted and sustained injuries to the right side of his head. After two weeks he notices dial his right eye is dry and it could not produce tears. from which ganglion is post synaptic fibers arise to supply lacrimal gland?
Pterygopalatine ganglion
Lacrimal Gland Peterggopalatine Ganglion
While the Parotid is Otic Ganglion
58
68- 50. A 35-year-old man undergoes a right inguinal hernia repair under genera! anaesthetic as a day patient. He has a nerve block after the procedure. On recovery he has weakness of the right leg. Which nerve has been affected?
Femoral nerve
Very Tricky Question yet it's a very common reall
Injury to the nerves after inguinal hernia surgery is uncommon. The femoral nerve may be damaged by suture or staples, tissue scar entrapment, local anesthesia blockade or direct compression. We present a case of a transient lesion of the femoral nerve after mesh hernioplasty for a re-recurrent inguinal hernia, confirmed by radiological studies, electrophysiology and clinical recovery. The diagnosis, mechanism of injury and surgical approach are reviewed. Surgery to a recurrent hernia may be underestimated. The role of electromyography nerve conducting studies is emphasized insisting on the importance of clinical evolution for the successful management of these infrequent injuries.
59
70- 52. A 60-year-old woman with breast carcinoma complains of difficulty chewing her .. food and is found to have numbness of the lower lip on one side. CT scanning shows a small metastatic lesion affecting the bony skull base on. The same side as the lip numbness. Which foramen is the most likely to involve?
Foramen ovale
Mandibular branch of the Trigeminal nerve CN V
59
72- 54. In order to expose the right axillary artery, a transverse skin incision is typically made below the clavicle from a point just lateral- to the sternal end of the clavicle to the deltopectoral groove. Which of the following structures would be encountered in the dissection down to the vessel?
Thoraco-acromial artery
59
69- 51. A man suffers a brachial plexus injury. On examination, he has a Horner's syndrome in association with upper limb paralysis. Which nerve roots does the Homer's syndrome suggest involvement of?
C8 & T1 roots
59
71- 53. Which one of the following muscles is an extensor of the hip?
Semitendinosus
60
73- 56. In the posterolateral approach to a posterior malleolar fracture, an incision is made between the calcaneal (Achilles) tendon and the distal -. fibula. Which of the following structures is at risk?
Sural nerve
61
74- 57. A 25-year-old woman undergoes.an elective right thoracoscopic procedure for treatment of right palmar hyperhidrosis. Diathermy is applied to a neural structure lying anterior to-the neck of tire right first rib. What is the most likely complication to occur as a result of this procedure?
Homer's syndrome
Sympathetic is running near the neck of the first rib so
similar to the concept of pancoast tumor
62
75- 58 / A 33-year-old man presents to the orthopedic outpatient clinic with a six-month history of low back pain radiating to the lateral aspect of the left upper thigh. Micturition and defecation are normal and there is no history of previous Injury. On examination, left lateral flexion of the spine is limited but a full range of hip movements are observed, although it is painful. Sensation is altered over the front of the knee. Left knee reflex is reduced. Which spinal nerve-is most likely to have been compressed?
L3
63
76- 60. On-an ultrasound scan of the popliteal fossa when investigating-a swelling, which of the following structures is closest to the capsule of the knee joint?
Popliteal artery
63
77- 61. A 25 years old man sustains a twisting injury while playing football. He develops immediate swelling of the knee and he can not continue the game. Six months later, he Is still not able to play football. His knee feels unsteady and tends to give way. On examination, he has a full range of knee motion. There is a positive anterior draw test and a small effusion. What is the most likely structure damaged?
Anterior cruciate ligament
anterior draw = ACL
posterior draw = PCL
valgus = MCL
Varus = LCL
64
78- 66. A 60-year-old man undergoes cystectomy a bladder carcinoma. During surgery, the ureters are identified. On which region of the bladder do the ureters pierce the bladder wall?
Posterior surface
65
79- 68. A 28-year-old man presents with an ischiorectal abscess. Where is ths abscess cavity likely to be sited?
Medial to the pudendal canal
66
80- 69. A 36-year-pld man falls on his outstretched right hand .- Examination reveals . tenderness in the anatomical snuffbox. Which one of the following tendons form a boundary of the anatomical snuff box?
Extensor poliicis longus
67
81- 71. A 40-year-old. woman presents with faecal incontinence and; anatomically intact internal and external anal- sphincters. Which structure is most likely to have been damaged?
Pudendal nerve
68
82- 72. Abdominal free fluid will collect in the lowest part of the peritoneal cavity. At operation with the patient supine, in which of the following will the fluid collect first?
Hepatorenal pouch
69
83- 77. A 3-year-old boy is admitted to hospital with severe vomiting. Radiographic examination and history reveals that he is suffering from annular pancreas. Which of these structures is constricted?
Second part of duodenum
70
84- 78. A 45 year-old man presents with a 3 cm * 4 cm swelling in the right groin which is non-tender. A cough impulse is elicited. At operation, an indirect inguinal hernia is found. The external inguinal ring is a defect in which of the following abdominal
External oblique aponeurosis
70
85- 80. A 23-year-old man presents to the Emergency Department-with non-specific: chest pains. A postero-anterior (PA) chest radiograph is performed and is normal. Immediately inferior cauidal to the outline of the aortic knuckle was a farther structure with a convex border. What is this structure?
The pulmonary trunk
71
86- 82. An 82-year-old man has complete occlusion of his inferior mesenteric artery on angiography but no symptoms or .signs of colonic ischaemia. Which of the following arteries is the .most likely additional source of blood supply to the territory of the inferior mesenteric artery?
Middle colic
72
87- 84. A 35-year-old man presents with a three-week history of low back pain and a three day history of pain and weakness in his left leg. Physical examination demonstrates numbness over the posterior aspect of the left calf extending to the lateral aspect, of the foot. Left ankle reflex is absent. A magnetic resonance scan shows compression of the left S1. nerve root. What is the most likely structure compressing the nerve?
Nucleus pulposus
72
88- 90. A 70-year-old man undergoes transurethral resection of bladder uimonr (TURBT). The tumour lies over the lateral side wall of the bladder just above the opening of the right ureteric orifice. Use of the diathermy suddenly causes the patient to 'kick' because of contraction of the hip adductors muscles. Which nerve has been stimulated?
Obturator nerve
73
89- 93. A 25-year-oid man is playing football when he complains of posterior thigh pain whilst sprinting with the ball. On examination he has tenderness in the lower lateral posterior thigh. He is unable to fully extend the knee due to pain. What is the most likely injury?
Biceps femoris tear
74
90- 94 . A 23 years old man is assaulted and sustains a stab injury to the left groin. The wound is cleaned and a simple dressing applied. Six months later the patient returns- with a pulsatile swelling in the site of the injury. The most probable lesion present is:
False aneurysm of the femoral artery
75
91- 95. 12 years old girl has a diastolic murmur it is maximally audible in the 2nd left intercostal space. Pathology of which structure is the most likely cause ?
Pulmonary valve
76
92- 98. A 21-year-old map comes into the Emergency Department with a severe headache and neck stiffness of recent onset. You suspect acute meningitis and decide immediately to treat with antibiotics and perform a lumbar puncture. After your third attempt to obtain for cerebrospinal fluid (CSF) you notice that the fluid obtained is stained red. However during the collection of CSF into three containers it is noted that the final bottle is now cleared of any blood. Which anatomical structure is the most likely to be responsible for this bleeding?
Vertebral venous plexus
77
94- 107. during recovery from varicose veins surgery 35 years old woman complains of weakness of dorsiflexion of the ankle Physical examination reveals absent sensation over the dorsum of the foot. Which of the following nerves is most likely injured?
Common peroneal nerve
Loss of Motor action of Deep peroneal Nerve & Sensory
Supply of Superficial Nerve = Common Peroneal Nerve
78
93- 104. A 29 year old pregnant woman is having uncontrolled labor pains. She has an epidural for pain relief. Which of the following is true?
A. An epidural puncture should only be performed below the L1 level to avoid damage to the spinal cord
B. An epidural puncture should only be performed below the L4 level to avoid the spinal cord
C.The epidural space (also known as the extradural space) contains numerous nerve roots and a venous plexus (Right)
D. The liganientum flavum is rarely pierced during a low epidural procedure
E. The supraspinous and interspinous ligaments are rarely pierced during the procedure .
79
95- 109. A 19-year-old man fell down a flight of stairs. On presentation to the Emergency Department his Glasgow coma scale (GCS) was 14/15 with no focal neurological signs. An hour later he vomited and his GCS deteriorated to 10. He developed a fixed and dilated left pupil -. Which of the following accounts for the pupillary signs?
Compression of oculomotor nerve parasympathetic fibres
ParaSympathetic Nerve = 1973
Occulomotor (3)
Sympathetic dilate
Parasympathetic constricts
When one is damaged the other dominates
When Parasympathetic damaged no constriction
Sympathetic dilatation dominate
80
96- 110. A 32-year-oid mountain biker presents to the outpatient clinic. He fell awkwardly, with excessive lateral flexion of his neck to the left side. He describes some paresthesia over his right shoulder and lateral arm. Which appears to have been improving over the past hour. What is the most likely injury suggested by this history?
Neuropraxia of the C5 nerve root
80
97- 113. A 26-year-old man presents to the Emergency Department with extensive bleeding from his arm, after sustaining a glass injury .- On examination- there is n 7 cm transverse laceration across tire anterior aspect of his elbow. On exploring the cubital fossa, you would expect the brachial artery to be?
lateral to the median nerve
81
99- 115. A 58-year-old woman, a known patient with thoracic right-sided meningioma, presents with features suggestive of a Brown-Sequard syndrome. The clinical, findings will include which of the following?
Right sided weakness, right sided proprioception and vibration loss, left sided loss of pin prick sensation
81
98- 112. A 50-year-old woman presents with a history of faecal incontinence over the past, few years. She had a prolonged and difficult first stage of labour 20 years previously. Physical examination reveals a relatively lax anal sphincter. Which nerve is likely to have been damaged in labour?
Pudendal nerve
82
100- 121. A 22-year-old men arrives in the Emergency Department with sudden breathlessness due to a large pneumothorax. An immediate chest drain is inserted into the fifth left intercostal space in the mid-axillary line, There is hemorrhage into the drainage bottle. Which of the following structures is the most likely cause of this acute hemorrhage ?
Intercostal artery m
83
101- 122. The right and left pulmonary arteries are derived from which of the following embryological aortic arches?
Sixth aortic arch
84
123. In the fetal circulation, the majority of blood passing from the inferior vena cava into tire right atrium subsequently passes next into which; one of the following?
Left atrium
85
103- 124. A 36-year-oid butcher injures his left index finger with a knife, suffering a deep laceration on the palmar aspect of the middle phalanx. On examination he is unable to flex DIP, which tendon is likely to have been injured?
Flexor digitorum profundus
86
104- A 39-year-old woman with large, expanding ovarian mass that is removed surgically, requiring a lateral pelvic wall clearance, of lymph nodes. Four days postoperatively she complains of painful spasms in the groin area and remarks that she has an area of numbness on the medial side of her thigh. The most likely explanation for these, problems is that during surgery an injury was inflicted on the:
Obturator nerve
87
106- 131. After resection of a rectal tumour a patient experiences erectile dysfunction. Which of the following nerves is most likely to have been damaged in surgery?
Pelvic splanchnic nerves
nervi erjentis is in close proximity to rectum = Pelvic splanchnic nerves
88
105- 127. A .surgeon is carrying out an elective splenectomy for congenital spherocytosis. Which structure will be divided in order to mobilise the spleen from the posterior Abdominal wall?
Lienoreaal ligament
89
107- A 30-year-old man is assaulted with a hammer and sustains a depressed fracture at the Vertex, of the skull Profuse venous bleeding is noted at the fracture site. Which vascular structure is most likely to have been perforated?
Superior sagittal sinus
90
108- 034. A 30-year-old man is assaulted with a hammer and sustains a depressed fracture at the Vertex, of the skull Profuse venous bleeding is noted at the fracture site. Which vascular structure is most likely to have been perforated?
Superior sagittal sinus
remember there is another important land mark in the skull called The Pterion it is the site for Middle menengeal artery mostly got injuried because it's the weakest point in the skull
91
109- 142. A 19- year-old man fell down a flight of stairs. On presentation to the Emergency Department his Glasgow Coma Score (GCS) was 14/15 with no local neurological signs. An bour later he Vomited and his GCS deteriorated to 10. He developed a fixed and dilated left pupil. Which of the following is likely to seen on the scan?
Left-sided extradural haematoma
92
110- 144. A 70-year-old woman from a nursing home is brought to' the Emergency Department with abdominal pain and vomiting. On examination, she is dehydrated and her abdomen is distended. There is a 3 cm x 4 cm swelling in the right groin which is nontender, and there is no cough impulse. At operation, a femoral hernia is found. Which one of the following lies immediately lateral to the hernial neck?
Femoral vein
93
111- 145. A 64-year-old woman is-reviewed in the Emergency Department with an acute right groin swelling, below and lateral to the pubic tubercle. Which of the following forms the medial boundary of the ring through which this hernia is protruding?
Lacunar ligament
93
114- 153. A 24-year-old man is assaulted and sustains a deep 2 cm long laceration to the lateral aspect of his lower leg. Physical examination show's that the laceration is anterior to the lateral malleolus. Which of the following structures is most at risk of being divided?
Superficial peroneal nerve
93
112- 149. A 58-year-old man, admitted for inguinal hernia surgery, is found to have an enlarged heart shadow on his chest radiograph. Which one of the/following statements is true of the right ventricle?
A. Has a muscular wall that is normally thicker than that of the Left ventricle
B. Forms the apex of the heart
C. Forms the right border of the heart
D. Is directly related to the diaphragm(Right)
E. Gives rise to the aorta
94
113- 150. A 67-year-oid man is admitted to hospital for investigation of at irregular heart beat. The 'conducting system' of the heart includes which one of the following anatomical structures?
Atrioventricular node
95
116- 161. A 75-year-old man presents with deep vein thrombosis. Computerized Tomography confirms the presence of a thrombus' in His common iliac vein extending into the inferior vena cava The common iliac veins join to form the inferior vena cava at which vertebral level?
L5
95
115- 160. A.58 year-old man is due to have surgery for Dupuytrens contracture to release the ring finger of the light hand. 'Which one of the following regarding the anatomy of the ring finger is correct?
A. Has a cutaneous innervation from the radial nerve(Right)
B. Has no cutaneous innervation from the median nerve
C. Has no cutaneous innervation from the ulnar nerve
D. Has the flexor digitorum profundus inserting into the middle phalanx
E. Is abducted by a palmar interosseous muscle
.......................................................
yes radial nerve innervation of the hand is masked by the ulnar and median nerve
96
118- 165. A 4-year-old boy presents to the Emergency Department with a two-day history of Headache, vomiting and drowsiness. A. CT scan reveals dilatation of both his lateral ventricles and his third cerebral ventricle: His fourth ventricle was of normal size. It is suspected that he has an obstruction to his cerebrospinal fluid flow At which of the following sites is the obstruction most likely to be?
Cerebral aqueduct of Sylvius
97
117- 162. A 35-year-old motorcyclist is involved in a road traffic accident and fractures his temporal bone, completely transecting the facial nerve just distal to the geniculate ganglion. Which function of this nerve remains?
Lacrimation
98
119- 167. During arch aortography, the vertebral artery would be seen to; a rise directly from which of the following?
Subclavian artery
99
120- 169. A 12-year-old child was admitted to the Emergency Department having inhaled a peanut. Where will the peanut most likely to have lodged?
Right lower lobe bronchus
100
123- 176. A 56-year-old man with chronic emphysema is on the high dependency unit (HDU), ten days after anterior resection. He has developed acute shortness of breath' and hypotension): Which of the following landmarks would be the most appropriate to use to obtain a femoral arterial blood gas sample?
A point midway between the anterior superior iliac-spine and the' pubic symphysis
100
121- 172. A-56 year old man presents with headache and vomiting with deterioration over the last two weeks. On examination he has papilledema. A CT scan shows a space occupying lesion in the right parietal lobe. He develops a sudden homonymous hemianopia. Which past of the visual system to be affected?
Optic radiation
101
122- 174. A 65 years old man with known ischemic heart disease and atrial fibrillation presents with a paralysis of his right lower limb. Which arterial territory is most likely to be involved?
Left anterior cerebral
