15- Anatomy general Recalls MSQs Only Flashcards
1
Q
1- A 19 year old female is admitted with suspected meningitis. The House Officer is due to perform a lumbar puncture. What is the most likely structure first encountered when the needle is inserted?
A
A. Ligamentum flavum
B. Denticulate ligament
C. Dural sheath
D. Pia Mater
E. Supraspinous ligament (Right)
Theme from September 2012 exam
Medical Mnemonics - Anaesthesia
LAYERS OF LUMBAR PUNCTURE
3S ILEDAS
. Skin
· Superficial fascia
· Supraspinous ligament
. Interspinous ligament
. Ligamentum flavum
. Epidural space containing the internal vertebral venous plexus
. Dura mater
. Arachnoid
· Subarachnoid space containing cerebrospinal fluid
2
Q
3- What is the correct embryological origin of the stapes?
A
Second pharyngeal arch
Embryological origin stapes = 2nd pharyngeal arch
Theme from April 2012 Exam
3
Q
2- A 34 year old male is being examined in the pre-operative assessment clinic. A murmur is identified in the 5th intercostal space just next to the left side of the sternum. From where is it most likely to have originated?
A
E. Tricuspid valve
Theme from September 2012 Exam
4
Q
4- Which muscle initiates abduction of the shoulder?
A
Supraspinatus
Theme from September 2012 exam
THE MUSCLES OF
SHOULDER ABDUCTION
STEP 1:
Abduction of the shoulder is initiated by the Supraspinatus muscle. Range of motion at glenohumeral joint = 0 to 15°
STEP 2:
The Deltoid muscle is the major abductor and abducts to 90°. Range of motion at glenohumeral joint = 15 to 90°
STEP 3:
The Trapezius and Serratus Anterior muscles rotates the scapula upwards. Range of motion at glenohumeral joint = 90 to 180°
5
Q
5- What is the most important structure involved in supporting the uterus?
A
Central perineal tendon
Theme from September 2012 Exam
6
Q
7- Which of the following structures is not transmitted by the jugular foramen?
A
Hypoglossal nerve
Contents of the jugular foramen:
Anterior: inferior petrosal sinus
Intermediate: glossopharyngeal, vagus, and accessory nerves
Posterior: sigmoid sinus (becoming the internal jugular vein) and some meningeal branches from the occipital and ascending pharyngeal arteries
Theme from 2009 exam
6
Q
6- 78 year old man is due to undergo an endarterectomy of the internal carotid artery. Which of the following nervous structures are most at risk during the dissection?
A
Hypoglossal nerve
Nerves at risk during a carotid endarterectomy:
Hypoglossal nerve
Greater auricular nerve
Superior laryngeal nerve
Theme from May 2011 exam
Theme from January 2013 Exam
7
Q
8- With regards to the jugular vein, which of the following statements is untrue?
A
A. It lies within the carotid sheath
B. It is the continuation of the sigmoid sinus
C. The terminal part of the thoracic duct crosses anterior to it to insert into the right subclavian vein (Right)
D. The hypoglossal nerve is closely related to it as it passes near the atlas
E. The vagus nerve is closely related to it within the carotid sheath
7
Q
9- A 28 year old man requires a urethral catheter to be inserted prior to undergoing a splenectomy. Where is the first site of resistance to be encountered on inserting the catheter?
A
Membranous urethra
Theme from 2011 exam
Theme from January 2012 Exam
Parts of Urethra:
Posterior urethra
(proximal urethra)- near to bladder
i) 4cm in length
ii) Lies in the pelvis
iii) It has 3 parts —–
a) pre-prostatic part-b/w bladder & prostate
b) prostatic part-within prostate
c) membranous part- through perineal
2] Anterior urethra (distal urethra)
i) 16 cm long
i) Lies in perineum & penis
ii) It has 2 parts –
a) bulbar urethra within bulb of penis
b)penile/pendulus urethra/spongy urethra
4.Anterior urethra
. It extends from membranous urethra to external urethral orifice
1) bulbar urethra- — lies in the bulbospongiosus (of penis)
— widest part of urethra
— Bulbourethral glands open in it
2)Penile urethra-
— lies in corpus spongiosum
— its terminal part is dilated in glans penis -k/a navicular fossa
- numerous urethral glands open in it
8
Q
10- A 23 year old man undergoes an orchidectomy. The right testicular vein is ligated; into which structure does it drain?
A
Inferior vena cava
9
Q
11- A 24 year old man falls and sustains a fracture through his scaphoid bone. From which of the following areas does the scaphoid derive the majority of its blood supply?
A
From the distal end
10
Q
12- Which of the following forms the medial wall of the femoral canal?
A
Lacunar ligament
Theme from September 2011 Exam
Theme from September 2012 Exam
11
Q
13- A 67 year old man is undergoing a transurethral resection of a bladder tumour using diathermy. Suddenly during the procedure the patients leg begins to twitch. Stimulation of which of the following nerves is the most likely cause?
A
Obturator
Theme from January 2011 Exam
Theme from January 2013 Exam
Obturator Nerve
L2-L4
Adductor Muscles
Major Action
HIP ADDUCTION
12
Q
14- A 5 year old boy is playing with some small ball bearings. Unfortunately he inhales one. To which of the following lung regions is the ball most likely to settle?
A
Right lower lobe
Theme from September 2011 Exam
Theme from January 2013 Exam
13
Q
16- A 43 year old lady is undergoing a total thyroidectomy for an extremely large goitre. The surgeons decide that access may be improved by division of the infra hyoid strap muscles. At which of the following sites should they be divided?
A
In their upper half
Theme from 2009 Exam
14
Q
15- An 18 year old man is cutting some plants when a small piece of vegetable matter enters his eye. His eye becomes watery. Which of the following is responsible for relaying parasympathetic neuronal signals to the lacrimal apparatus?
A
Pterygopalatine ganglion
Theme from January 2013 Exam
15
Q
17- A 22 year old women has recently undergone a surgical excision of the submandibular gland. She presents to the follow up clinic with a complaint of tongue weakness on the ipsilateral side to her surgery. Which nerve has been damaged?
A
Hypoglossal nerve
Three cranial nerves may be injured during submandibular gland excision.
Marginal mandibular branch of the facial nerve
Lingual nerve
Hypoglossal nerve
Theme from April 2012 Exam
16
Q
18- You decide to take an arterial blood gas from the femoral artery. Where should the needle be inserted to gain the sample?
A
Mid inguinal point
Theme from September 2012 Exam
17
Q
19- A 67 year old man undergoes a carotid endarterectomy and seems to recover well following surgery. When he is reviewed on the ward post operatively he complains that his voice is hoarse. What is the most likely cause?
A
Damage to the vagus
Theme from April 2013 Exam
18
Q
20- A 25 year old man has an inguinal hernia, which of the following structures must be divided (at open surgery) to gain access to the inguinal canal?
A
External oblique aponeurosis
Theme from January 2013 Exam
19
Q
22- A 67 year old man has an abdominal aortic aneurysm which displaces the left renal vein. Which branch of the aorta is most likely to affected at this level?
A
Superior mesenteric artery
Theme from April 2013 Exam
20
Q
21- A 34 year old man is shot in the postero- inferior aspect of his thigh. Which of the following lies at the most lateral aspect of the popliteal fossa?
A
Common peroneal nerve
Theme from April 2012 Exam
20
Q
23- A 12 year old boy undergoes surgery for recurrent mastoid infections. Post operatively he complains of an altered taste sensation. Which of the following nerves has been injured?
A
Chorda tympani
Theme from April 2012 Exam
21
Q
24- What is the anatomical level of the transpyloric plane?
A
L1
Theme from September 2012 Exam
Theme from January 2013 Exam
TRANSPYLORIC PLANE
(Horizontal line half way between suprasternal notch & pubic symphysis)
Structures approximately on this line:
End of spinal cord
L1 vertebral body
Origin of superior mesenteric art
Origin of portal vein
Neck of pancreas
Pylorus of the stomach
Second part of duodenum
Sphincter of Oddi
Hilum of each kidney
Duodenojejunal flexure
Fundus of gall bladder
Tips of ninth costal cartilages
22
26- A 33 year old man sustains an injury to his forearm and wrist. When examined in clinic he is unable to adduct his thumb. What is the most likely underlying nerve lesion?
Deep branch of the ulnar nerve
Theme from April 2013 Exam
23
25- A 35 year old man falls and sustains a fracture to the middle third of his clavicle. Which vessel is at greatest risk of injury?
Subclavian vein
Theme from April 2013 Exam
24
28- A 22 year old man is stabbed in the chest at the level of the junction between the sternum and manubrium. Which structure is at greatest risk?
Aortic arch
Theme from 2009 Exam
25
27- A 63 year old man who smokes heavily presents with dyspepsia. He is tested and found to be positive for helicobacter pylori infection. One evening he has an episode of haematemesis and collapses. What is the most likely vessel to be responsible?
Gastroduodenal artery
Theme from January 2012 exam
25
29- Which of the following nerves passes through the greater and lesser sciatic foramina?
Pudendal nerve
Structures passing through the lesser and greater sciatic foramina (medial to lateral): PIN
Pudendal nerve
Internal pudendal artery
Nerve to obturator internus
Theme from 2010 Exam
Theme from January 2013 Exam
26
30- A 73 year old lady is admitted with brisk rectal bleeding. Despite attempts at resuscitation the bleeding proceeds to cause haemodynamic compromise. An upper GI endoscopy is normal. A mesenteric angiogram is performed and a contrast blush is seen in the region of the sigmoid colon. The radiologist decides to embolise the vessel supplying this area. At what spinal level does it leave the aorta?
L3
27
32- A 21 year old man is stabbed in the antecubital fossa. A decision is made to surgically explore the wound. At operation the surgeon dissects down onto the brachial artery. A nerve is identified medially, which nerve is it likely to be?
Median
Theme from September 2012 Exam
27
34- A man sustains a laceration between the base of the little finger and wrist. Several weeks after the injury there is loss of thumb adduction power. Which nerve is most likely to have been injured?
Deep ulnar nerve
Theme from 2009 Exam
27
33- A 65 year old man with long standing atrial fibrillation develops an embolus to the lower leg. The decision is made to perform an embolectomy, utilising a trans popliteal approach. After incising the deep fascia, which of the following structures will the surgeons encounter first on exploring the central region of the popliteal fossa?
Tibial nerve
Theme from 2009 Exam
Theme from January 2013 Exam
28
36- A 43 year old man is due to undergo an excision of the sub mandibular gland. Which of the following incisions is the most appropriate for this procedure?
A transversely orientated incision 4cm below the mandible
28
31- In which space is a lumbar puncture performed?
Subarachnoid space
Theme from January 2013 exam
29
35- What is the course of the median nerve relative to the brachial artery in the upper arm?
Lateral to anterior to medial
....................................................
Relations of median nerve to the
brachial artery:
Lateral -> Anterior -> Medial
Theme from 2009 and 2012 Exams
30
37- A 5 year old boy presents with recurrent headaches. As part of his assessment he undergoes an MRI scan of his brain. This demonstrates enlargement of the lateral and third ventricles. Where is the most likely site of obstruction?
Aqueduct of Sylvius
Theme based on September 2011 Exam
Theme based on April 2012 Exam
Theme from September 2012 Exam
Point of Obstruction: Aqueduct of Sylvius
Characteristic finding:
. Enlargement of the lateral and 3rd ventricles
. Normal 4th ventricle
Causes:
. Tumor
. Stenosis
. Web
. Hemorrhage
31
38- Where does the spinal cord terminate in neonates?
L3
Theme from 2009 Exam
Theme from January 2013 Exam
POSITIONAL CHANGES OF SPINAL CORD:
lnitially, the spinal cord occupies the whole length of the vertebral canal.
As a result a faster growth of vertebral column, the caudal end of spinal cord (conus medullaris) shift gradually to a higher level.
32
39-A 73 year old lady is admitted with acute mesenteric ischaemia. A CT angiogram is performed and a stenotic lesion is noted at the origin of the superior mesenteric artery. At which of the following levels does this branch from the aorta?
L1
33
40- Following an oesophagogastrectomy the surgeons will anastomose the oesophageal remnant to the stomach, which of the following is not part of the layers that comprise the oesophageal wall?
A. Serosa(Right)
B. Adventitia
C. Muscularis propria
D. Submucosa
E. Mucosa
...................................................
The oesophageal wall lacks the serosa layer
Theme from April 2010 exam
34
41- Where is the 'safe triangle' for chest drain insertion located?
5th intercostal space, mid axillary line
'Safe Triangle' for chest drain
insertion:
5th intercostal space, mid axillary line
Theme from April 2012 exam
Thoracic Trauma
Life Threatening Injuries:
. Flail chest out
. Tracheobronchial injury now in
. Tension pneumothorax:
· Needle thoracocentesis
. 5th ICS MAL for adult
- UNCHANGED 2nd ICS for child
28-32 Fr chest drain for hemothorax (not 36-40 Fr)
. Algorithm for circulatory arrest approach
. Aortic rupture management with Beta Blocker
. Trauma team
35
42- Your consultant decides to perform an open inguinal hernia repair under local anaesthesia. Which of the following dermatomal levels will require blockade?
T12
Theme from April 2012 Exam
36
43- Which of the following does not pass through the superior orbital fissure?
Opthalmic artery
Mnemonic for the nerves
passing through the
supraorbital fissure:
Live Frankly To See
Absolutely No Insult
Lacrimal
Frontal
Trochlear
Superior Division of
Oculomotor
Abducens
Nasociliary
Inferior Division of
Oculomotor nerve
Theme from January 2012 Exam
37
44- patient is found to have an ischaemic left colon. Which artery arising from the aorta at around the level of L3, is most likely to account for this situation?
Inferior mesenteric artery
Theme from January 2013 Exam
38
45- At which level does the aorta perforate the diaphragm?
T12
Memory aid:
T8 (8 letters) = vena cava
T10 (10 letters) = oesophagus
T12 (12 letters) = aortic hiatus
Theme from April 2012 exam
39
46- A 24 year old lady is stabbed in the buttock. Following the injury the wound is sutured in the emergency department. Eight weeks later she attends the clinic, as she walks into the clinic room she has a waddling gait and difficulty with thigh abduction. On examination she has buttock muscle wasting. Which nerve has been injured?
Superior gluteal nerve
Theme from April 2012 Exam
40
47- At which level is the hilum of the left kidney located?
L1
Remember L1 ('left one') is the level of the
hilum of the left kidney
Theme from April 2012 exam
41
48- A 73 year old lady presents with symptoms of faecal incontinence. On examination she has weak anal sphincter muscles. What are the main nerve root values of the nerves supplying the external anal sphincter?
S2,3,4
Theme from September 2011 Exam
42
49- A 72 year old man has a fall. He is found to have a fractured neck of femur and goes on to have a left hip hemiarthroplasty. Two months post operatively he is found to have an odd gait. When standing on his left leg his pelvis dips on the right side. There is no foot drop. What is the cause?
Superior gluteal nerve damage
Theme from 2010 Exam
43
50- A 28 year old lady requires an episiotomy for a ventouse vaginal delivery. Which of the nerves listed below will usually be anaesthetised to allow the episiotomy?
Pudendal
Theme from April 2013 Exam
Ischeal Spine is the Land Mark
44
51- A 48 year old lady is undergoing an axillary node clearance for breast cancer. Which of the structures listed below are most likely to be encountered during the axillary dissection?
Thoracodorsal trunk
Beware of damaging the thoracodorsal trunk if a latissimus dorsi flap reconstruction is planned.
Theme from 2009 Exam
44
52- A 53 year old lady is recovering following a difficult mastectomy and axillary nodal clearance for carcinoma of the breast. She complains of shoulder pain and on examination has obvious winging of the scapula. Loss of innervation to which of the following is the most likely underlying cause?
Serratus anterior
Theme from April 2012 Exam
45
55- Which of the following ligaments contains the artery supplying the head of femur in children?
Ligamentum teres
Theme from 2010 Exam
45
53- A 56 year old lady is referred to the colorectal clinic with symptoms of pruritus ani. On examination a polypoidal mass is identified inferior to the dentate line. A biopsy confirms squamous cell carcinoma. To which
of the following lymph node groups will the lesion potentially metastasise?
Inguinal
Theme from September 2011 Exam
Theme from April 2012 Exam
46
54- A 20 year old man is hit with a hammer on the right side of the head. He dies on arrival in the emergency department. Which of these features is most likely to be found at post mortem?
Laceration of the middle meningeal artery
Theme based on 2011 exam
47
56- A 63 year old man is undergoing a coronary artery bypass procedure. During the median sternotomy which structure would routinely require division?
Interclavicular ligament
Theme from January 2011 Exam
48
57- A man undergoes a high anterior resection for carcinoma of the upper rectum. Which of the following vessels will require ligation?
Inferior mesenteric artery
Theme from April 2013
49
59- A 60 year old female attends the preoperative hernia clinic. She reports some visual difficulty. On examination she is noted to have a homonymous hemianopia. Where is the lesion most likely to be?
Optic tract
…………………………………..
Lesions before optic chiasm:
Monocular vision loss = Optic nerve lesion
Bitemporal hemianopia = Optic chiasm lesion
Lesions after the optic chiasm:
Homonymous hemianopia = Optic tract lesion
Upper quadranopia = Temporal lobe lesion
Lower quadranopia = Parietal lobe lesion
Theme from April 2012 exam
50
61- Following a carotid endarterectomy a man notices that he has a weakness of his tongue. Damage to which of the following nerves is the most likely explanation for this process?
Hypoglossal
Theme from April 2013
50
58- What are the boundaries of the 'safe triangle' for chest drain insertion?
Bounded by latissimus dorsi, pectoralis major, line superior to the nipple and apex at the axilla
Theme from April 2012 Exam
51
60- A 23 year old climber falls and fractures his humerus. The surgeons decide upon a posterior approach to the middle third of the bone. Which of the following nerves is at greatest risk in this approach?
Radial
Theme from April 2012 Exam
Radial Nerve
Course & Distribution In the Arm
It winds() around the back of the arm in the Spiral Groove(radial groove) on the back of the humerus between the heads of the triceps.
In the spiral groove, the nerve is accompanied by(with) the Profunda Vessels, and it lies directly in contact with the shaft of the humerus (Dangerous Position).
Any fracture of humerus specifically the spiral groove leads to injury of the radial nerve
52
63- Which of the following structures lies deepest in the popliteal fossa?
Popliteal artery
52
64- What is the nerve root value of the external urethral sphincter?
S2, S3, S4
52
62- At which of the following levels does the inferior vena cava exit the abdominal cavity?
T8
53
65- A patient presents to the clinic following a surgical procedure. She complains that she is unable to shrug her shoulder. What is the most likely underlying nerve injury?
Accessory nerve
Theme from April 2013 Exam
54
66- A 32 year old man is undergoing a splenectomy. Division of which of the following will be necessary during the procedure?
Short gastric vessels
55
67- A patient has a chest drain insertion. There is fresh blood at the chest drain insertion area. Which vessel has been damaged?
Intercostal artery
Theme from 2009 Exa
55
68- Two teenagers are playing with an airgun when one accidentally shoots his friend in the abdomen. He is brought to the emergency department. On examination there is a bullet entry point immediately to the right of the rectus sheath at the level of the 1st lumbar vertebra. Which of the following structures is most likely to be injured by the bullet?
Fundus of the gallbladder
56
69- Which of the following nerves is not contained within the posterior triangle of the neck?
Ansa cervicalis
57
70- A 42 year old lady is reviewed in the outpatient clinic following a routine surgical procedure. She complains of diminished sensation at the lateral aspect of her foot. Which of the following nerves is likely to be affected?
Sural
57
71- A sprinter attends A&E with severe leg pain. He had forgotten to warm up and ran a 100m sprint race. Towards the end of the race he experienced pain in the posterior aspect of his thigh. The pain worsens, localising to the
lateral aspect of the knee. The sprinter is unable to flex the knee. What structure has been injured?
Biceps femoris tendon
Theme from 2009 Exam
The biceps femoris is located in the back of the thigh.
It is comprised of two heads, the long head and the short head.
The long head connects the pelvis (ischial tuberosity) to the lower leg (fibula).
The short head connects the the upper leg (linea aspera of femur) to the lower leg (fibula)
58
72- Which nerve supplies the interossei of the fourth finger?
Deep ulnar
Mnemonic:
PAD and DAB
Palmer interossei
ADduct
Dorsal interossei ABuct
58
73- A 45 year man presents with hand weakness. He is given a piece of paper to hold between his thumb and index finger. When the paper is pulled, the patient has difficulty maintaining a grip. Grip pressure is maintained by
flexing the thumb at the interphalangeal joint. What is the most likely nerve lesion?
Deep branch of ulnar nerve
59
74- Which of the following cranial foramina pairings are incorrect?
A. The foramen lacerum and internal carotid artery.
B. Foramen ovale and mandibular nerve.
C. Optic canal and ophthalmic artery.
D. Optic canal and ophthalmic nerve.(Right)
E. Foramen rotundum and maxillary nerve.
Question derived from 2010 and 2011 exams
59
77- A 23 year old man is injured during a game of rugby. He suffers a fracture of the distal third of his clavicle, it is a compound fracture and there is evidence of arterial haemorrhage. Which of the following vessels is most
likely to be encountered first during subsequent surgical exploration?
Thoracoacromial artery
59
75- A man has an incision sited than runs 8cm from the deltopectoral groove to the midline.
Which of the following is not at risk of injury?
A. Cephalic vein
B. Shoulder joint capsule (Right)
C. Axillary artery
D. Pectoralis major
E. Trunk of the brachial plexus
60
76- A surgeon is due to perform a laparotomy for perforated duodenal ulcer. An upper midline incision is to be performed. Which of the following structures is the incision most likely to divide?
Linea alba
61
80- During the course of a radical gastrectomy the surgeons detach the omentum and ligate the right gastro-epiploic artery. From which vessel does it originate?
Gastroduodenal artery
Theme from January 2013 Exam
62
79- A 23 year old man is involved in a fight, during the dispute he sustains a laceration to the posterior aspect of his right arm, approximately 2cm proximal to the olecranon process. On assessment in the emergency department he is unable to extend his elbow joint. Which of the following tendons is most likely to have been cut?
Triceps
63
78- What is the most useful test to clinically distinguish between an upper and lower motor neurone lesion of the facial nerve?
Raise eyebrow
Upper motor neurone lesions of the facial nerve- Paralysis of the lower half of face.
Lower motor neurone lesion- Paralysis of the entire ipsilateral face.
Theme from April 2012 Exam
63
81- A 43 year old man is reviewed in the clinic following a cardiac operation. A chest x-ray is performed and a circular radio-opaque structure is noted medial to the 4th interspace on the left. Which of the following procedures is the patient most likely to have undergone?
Mitral valve replacement with metallic valve
Theme from April 2012 Exam
the trick is to differentiate between anatomical site and auscaltatory site notice the arrows point to the site where you hear the valve
64
82- A 63 year old lady is diagnosed as having an endometrial carcinoma arising from the uterine body. To which nodal region will the tumour initially metastasise?
Iliac lymph nodes
Theme from 2011 exam
65
84- Which of the following nerves is responsible for the motor innervation of the sternocleidomastoid muscle?
Accessory nerve
....................................................
Sternocleidomastoid Muscle
It is the Key Muscle of the Neck It divides the neck into anterior and posterior triangles. Its anterior border covers carotid arteries, internal jugular vein, and deep cervical lymph nodes; it also overlaps thyroid gland. It is covered superficially by skin, fascia, platysma muscle and external jugular vein. Deep surface of posterior border is related to cervical plexus of nerves, phrenic nerve, and upper part of brachial plexus.
Origin: Manubrium sterni (sternal head) and medial third of clavicle (clavicular head)
Insertion: Mastoid process of temporal bone and occipital bone
Action: Two muscles acting together flex neck draw head forward; one muscle rotates face to opposite side.
Nerve Supply: Spinal part of accessory nerve and anterior rami of C2 & C3.
65
83- A 23 year old lady is undergoing a trendelenberg procedure for varicose veins. During the dissection of the saphenofemoral junction, which of the structures listed below is most liable to injury?
Deep external pudendal artery
66
85- A 42 year old lady has had an axillary node clearance for breast malignancy. Post operatively she reports weakness of the shoulder. She is unable to push herself forwards from a wall with the right arm and the scapula is pushed out medially from the chest wall. What is the most likely nerve injury?
Long thoracic nerve
Theme from January 2012 and 2009
66
87- A 17 year old male presents to the clinic. He complains of difficulty using his left hand. It has been a persistent problem since he sustained a distal humerus fracture as a child. On examination there is diminished sensation overlying the hypothenar eminence and medial one and half fingers. What is the most likely nerve lesion?
Ulnar nerve
67
86- A 36 year old male is admitted for elective surgery for a lymph node biopsy in the supraclavicular region. Post operatively the patient has difficulty shrugging his left shoulder. What nerve has been damaged?
Accessory nerve
68
88- A 56 year old man is undergoing a pancreatectomy for carcinoma. During resection of the gland which of the following structures will the surgeon not encounter posterior to the pancreas itself?
Gastroduodenal artery
Theme from 2010 Exam
Relations of pancreas
Body of pancreas
Anteriorly:
Separated from stomach by
omental bursa
Posteriorly:
Abdominal aorta
Left suprarenal gland
Left kidney
Left renal vessels
Spleen vein
Superiorly:
Celiac trunk
Celiac plexus
Splenic a.
69
89- Which of the following bones is related to the cuboid at its distal articular surface?
5th metatarsal
70
91- A 56 year old man undergoes an abdomino-perineal excision of the rectum. He is assessed in the outpatient clinic post operatively. His wounds are well healed. However, he complains of impotence. Which of the following best explains this problem?
Damage to the hypogastric nerve plexus
70
90- A 34 year old lady presents with symptoms of faecal incontinence. Ten years previously she gave birth to a child by normal vaginal delivery. Injury to which of the following nerves is most likely to account for this process?
Pudendal
71
92- A woman develops winging of the scapula following a Patey mastectomy. What is the most likely cause?
Damage to the long thoracic nerve during axillary dissection
MODIFIED RADICAL MASTECTOMY
*TYPES:
It is of 3 types:
1.Patey's Modified Radical Mastectomy: Pectoralis major muscle is preserved and Pectoralis minor removed.
2. Scanlon's Modified Radical Mastectomy: Pectoralis minor muscle is divided but not removed.
3.Auchincloss' Modified Radical Mastectomy: Pectoralis minor is retraced but not divided.
Auchincloss' Modified Radical Mastectomy is widely practiced nowadays.
72
93- Which nerve directly innervates the sinoatrial node?
A. Superior cardiac nerve ter
B. Right vagus nerve
C. Left vagus nerve
D. Inferior cardiac nerve
E. None of the above (Right)
72
94- A 30 year old man presents with back pain and the surgeon tests the ankle reflex. Which of the following nerve roots are tested in this manoeuvre?
S1 and S2
73
95- An 18 year old male presents to casualty with a depressed skull fracture. This is managed surgically. Over the next few days he complains of double vision on walking down stairs and reading. On examination the left eye cannot look downwards and medially. Which of the nerves listed below is most likely to be responsible?
Trochlear
73
97- A 56 year old man is having a long venous line inserted via the femoral vein into the right atrium for CVP measurements. The catheter is advanced through the IVC. At which of the following levels does this vessel enter the thorax?
T8
74
96- A 16 year old boy is hit by a car and sustains a blow to the right side of his head. He is initially conscious but on arrival in the emergency department is comatose. On examination his right pupil is fixed and dilated. The neurosurgeons plan immediate surgery. What type of initial approach should be made ?
Right parieto-temporal craniotomy
75
98- A 23 year old man falls and injures his hand. There are concerns that he may have a scaphoid fracture as there is tenderness in his anatomical snuffbox on clinical examination. Which of the following forms the posterior border of this structure?
Extensor pollicis longus
Theme from 2009 Exam
Theme from September 2012 Exam
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99- The integrity of which muscle is assessed by the Trendelenberg test?
Gluteus medius
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100- Which of the following regions of the male urethra is entirely surrounded by Bucks fascia?
Spongiose part
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101- A 73 year old man has a large abdominal aortic aneurysm. During a laparotomy for planned surgical repair the surgeons find the aneurysm is far more proximally located and lies near the SMA. During the dissection a vessel lying transversely across the aorta is injured. What is this vessel most likely to be?
Left renal vein
Superior mesenteric artery syndrome (SMAS):
Superior mesenteric artery syndrome is a rare condition first described by Rokitansky in1861. The condition results from a reduced angle between the artery at its origin from the abdominal aorta and the transverse third part of the duodenum causing duodenal obstruction. Diagnosis of the syndrome depends on high index of suspicion, augmented by the radiological features of the syndrome. Treatment can either be conservative or operative, depending on the severity of the condition.
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104- Which of the following structures does not lie posterior to the right kidney?
A. Psoas major
B. Transversus abdominis
C. Quadratus lumborum
D. Medial artcuate ligament
E. 10th rib (Right)
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102- A 56 year old machinist has his arm entrapped in a steel grinder and is brought to the emergency department. On examination, he is unable to extend his metacarpophalangeal joints and abduct his shoulder. He has weakness of his elbow and wrist. What has been injured?
Posterior cord of brachial plexus
The posterior cord gives rise to:
Radial nerve ((innervates the triceps, brachioradialis, wrist extensors, and finger extensors)
Axillary nerve (innervates deltoid and teres minor)
Upper subscapular nerve (innervates subscapularis)
Lower subscapular nerve (innervates teres major and subscapularis)
Thoracodorsal nerve (innervates latissimus dorsi)
Theme from September 2012
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103- A 60 year old female is undergoing a Whipples procedure for adenocarcinoma of the pancreas. As the surgeons begin to mobilise the pancreatic head they identify a large vessel passing inferiorly over the anterior aspect of the pancreatic head. What is it likely to be?
Superior mesenteric artery
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106- A 20 year old man undergoes an open appendicectomy performed via a lanz incision. This surgeon places the incision on a level of the anterior superior iliac spine in an attempt to improve cosmesis. During the procedure the appendix is found to be retrocaecal and the incision is extended laterally. Which of the following nerves is at greatest risk of injury?
Ilioinguinal
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105- Which of the following muscles is not within the posterior compartment of the lower leg?
A. Peroneus brevis (Right)
B. Flexor digitalis longus
C. Soleus
D. Popliteus
E. Flexor hallucis longus
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107- A 32 year old man is stabbed in the neck and the inferior trunk of his brachial plexus is injured. Which of the modalities listed below is least likely to be affected?
Initiating abduction of the shoulder
.......................................................
Inferior trunk of brachial plexus.
C8 and T1 roots
Contributes to ulnar nerve and part of median nerve
Theme from September 2012 Exam
SHOULDER ABDUCTION
Abduction of the shoulder is
initiated by the Supraspinatus;
0 to15.
The Deltoid muscle can then
abduct to 90°. Its the major
abductor. 15° to 90°
180° (elevation) is brought about by
rotation of the scapula upwards by
the Trapezius and Serratus anterior.
Axillary Nerve Injury: Causes Deltoid and teres minor
paralysis, Loss of rounded contour of shoulder,
Sensory loss in skin covering lower part of deltoid
(regimental badge anaesthesia), Loss of Abduction
from 15° to 90.
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108- A 23 year old man presents with delayed diagnosis of appendicitis. The appendix is retrocaecal and has perforated causing a psoas abscess. Into which structure does the psoas major muscle insert?
Lesser trochanter of the femur
.........................................................
Iliopsoas
Combination of 3 muscles:
Psoas major
Psoas minor
Iliacus
Location : Abdomen
Movement :
Torso Flexion
Hip Flexion
Extras
Origin -
Anterior surfaces and lower borders of transverse processes of L1 - L5 and bodies and discs of T12 - L5
Insertion: Lesser trochanter
Nerve Supply: Direct fibers of L1 - L3 of lumbar D-B plexus (L1, L2, L3)
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109- A 63 year old man is due to undergo a splenectomy. Which splenic structure lies most posteriorly?
Lienorenal ligament
The gastrosplenic ligament contains the short gastric & left gastro-epiploic vessels
The lienorenal ligament contains the tail of pancreas &
splenic vessels)
The two ligments are the remnants of the the dorsal mesentery of the stomach. The ventral mesentery is the lesser omentum and the falciform ligament
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110- A 62 year old man presents with arm weakness. On examination he has a weakness of elbow extension and loss of sensation on the dorsal aspect of the first digit. What is the site of the most likely underlying defect?
Radial nerve
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111- 44. A 43 year old typist presents with pain at the dorsal aspect of the upper part of her forearm. She also complains of weakness when extending her fingers. On examination triceps and supinator are both functioning normally. There is weakness of most of the extensor muscles. However, there is no sensory deficit.
Take Care if You have answered Radial nerve
The correct answer is Posterior interosseous nerve
..............................................................
The radial nerve may become entrapped in the "arcade of Frohse" which is a superficial part of the supinator muscle which overlies the posterior interosseous nerve. This nerve is entirely muscular and articular in its distribution. It passes postero-inferiorly and gives branches to extensor carpi radialis brevis and supinator. It enters supinator and curves around the lateral and posterior surfaces of the radius. On emerging from the supinator the posterior interosseous nerve lies between the superficial extensor muscles and the lowermost fibres of supinator. It then gives branches to the extensors.
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112- 45. A 28 year teacher reports difficulty with writing. There is no sensory loss. She is known to have an aberrant Gantzer muscle.
The correct answer is Anterior interosseous nerve
Anterior interosseous lesions occur due to fracture, or rarely due to compression. The Gantzer muscle is an aberrant accessory of the flexor pollicis longus and is a risk factor for anterior interosseous nerve compression. Remember loss of pincer grip and normal sensation indicates an interosseous nerve lesion.
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113- 46. A 35 year tennis player attends reporting tingling down his arm. He says that his 'funny bone' was hit very hard by a tennis ball. There is weakness of abduction and adduction of his extended fingers.
The correct answer is Ulnar nerve
Theme from September 2012 exam
The ulnar nerve arises from the medial cord of the brachial plexus (C8, T1 and contribution from C7).
The nerve descends between the axillary artery and vein, posterior to the cutaneous nerve of the forearm and then lies anterior to triceps on the medial side of the brachial artery. In the distal half of the arm it passes through the medial intermuscular septum, and continues between this structure and the medial head of triceps to enter the forearm between the medial epicondyle of the humerus and the olecranon. It may be injured at this site in this scenario
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114- In relation to the middle cranial fossa, which of the following statements relating to the foramina are incorrect?
A. The foramen rotundum transmits the maxillary nerve
B. The foramen lacerum transmits the internal carotid artery
C. The foramen spinosum lies posterolateral to the foramen ovale
D. The foramen ovale transmits the middle meningeal artery(Right)
E. The foramen rotundum lies anteromedial to the foramen ovale
.....................................................................
Theme addressed in 2010 and 2011 exam
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115- During an operation for varicose veins the surgeons are mobilising the long saphenous vein. Near its point of entry to the femoral vein an artery is injured and bleeding is encountered. From where is the bleeding most likely to originate?
Deep external pudendal artery
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116- What is embryological origin of the pulmonary artery?
Sixth pharyngeal arch
Theme from September 2011 Exam
Theme from September 2012 Exam
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117- A 53 year old lady presents with pain and discomfort in her hand. She works as a typist and notices that the pain is worst when she is working. She also suffers symptoms at night. Her little finger is less affected by the pain. Which of the nerves listed below is most likely to be affected?
Median
Take care for the recurrent motor branch of the median nerve during carpal tunnel release
Motor supply: LOAF
L ateral 2 lumbricals
O pponens pollicis
A bductor pollicisbrevis
F lexor pollicis brevis
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118- Which of the following muscles lies medial to the long thoracic nerve?
Serratus anterior
The long thoracic nerve originates from the C5-C7 roots and descends in the axilla, posterior to the brachial plexus, to innervate the serratus anterior muscle, which anchors the scapula to the chest wall. Injuries to the long thoracic nerve cause winging of the scapula, especially with the arm in anterior abduction.
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119- A 25 year old man is being catheterised, prior to a surgical procedure. As the catheter enters the prostatic urethra which of the following changes will occur?
Resistance will decrease
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120- Which of the following nerves is the primary source of innervation to the anterior scrotal skin?
Ilioinguinal nerve
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122- A 72 year old lady with osteoporosis falls and sustains an intracapsular femoral neck fracture. The fracture is completely displaced. Which of the following vessels is the main contributor to the arterial supply of the femoral head?
Circumflex femoral arteries
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121- A 38 year old man presents to the clinic with shoulder weakness. On examination he has an inability to initiate shoulder abduction. Which of the nerves listed below is least likely to be functioning normally?
A. Suprascapular nerve(Right)
B. Medial pectoral nerve
C. Axillary nerve
D. Median nerve
E. Radial nerve
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123- A 21 year old man is hit with a hammer and sustains a depressed skull fracture at the vertex. Which of the following sinuses is at risk in this injury?
Superior sagittal sinus
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124- A 19 year old man is playing rugby when he suddenly notices a severe pain at the posterolateral aspect of his right thigh. Which of the following muscle groups is most likely to have been injured?
Long head of biceps femoris
