19- Fawzia Orthopedics MSQs (1) Flashcards
1- A 50-year-old woman attends her Genera) Practitioner due to a change in appearance. She finds difficulty removing her rings, reports: an increase ‘in shoe size and photographs reveal a change in her facial appearance. Visual field tests are-performed to direct confrontation. Which of the following defects is most likely to be associated with her presentation?
Bitemporal hemianopia
2- 60-year-old man presents with a short history of pain in the right cheek and right upper teeth Maxillary sinus infection is diagnosed. This sinus is particularly prone to infection because of?
Position of the sinus ostium high on the medial wall
3- 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?
Interspinous ligament
4- 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?
Lacunar ligament
8- 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?
Supraspinatus
5- 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:
lateral to the median nerve
6- 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?
S1
7- 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?
Right ventricle
10- In describing the sino-atrial node, which one of the following statements is correct?
A it is part of the somatic nervous system
B It is usually supplied by the left coronary artery
C If lies in the wall of the left atrium
D It lies in the wall of the right ventricle
E It receives fibers derived from the vagus nerves(Right)
11- A 45-year-old man presents with fever and pain in his right loin and groin. A soft swelling was noted in his femoral triangle. Diagnosis of a psoas abscess was made. Which of the following statements is most accurate regarding psoas major?
It arises from the lateral borders of the bodies of T12 to L5
……………………………………………………..
Origin:
Bodies, transverse processes and intervertebral discs of all lumbar vertebrae and T12
Insertion:
Top of femur (shares tendon with iliacus)
Joints crossed:
· Hip and intervertebral joints of lumbar vertebrae
Joint action:
Origin fixed: flexes hip
Insertion fixed: pulls on spine to increase the lumbar lordosis
Unilaterally: assists in lateral flexion of the trunk
Stabilises lumbar spine
12- Which one of me following muscles is an extensor of the hip?
Semitendinosus
13- 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?
Posterior to the left renal vein
14- Within the posterior triangle, which nerve is at particular risk of damage during surgery?
Spinal accessory
Spinal Acc nerve = Nerve supply to Trapezius and Sternocleidomastoid
POSTERIOR TRIANGLE OF NECK
· Boundaries: Posterior border of sternocleidomastoid, anterior border of trapezius, mid 1/3 clavicle
. Shape: Spiral
· Roof: Investing fascia, platysma, external jugular vein
· Floor: Prevertebral fascia covering muscles, subclavian artery, trunks of brachial plexus & cervical plexus
· Contents:
· Arteries: Occipital, superficial cervical, suprascpular
· Veins: Transverse cervical, suprascapular, external jugular
. Nerves: Branches of cervical plexus, spinal root of accessory
. Muscle: Omohyoid with its sling
. Lymph nodes: Occipital (rubella/scalp infections)
Supraclavicular (part of the deep chain)
15- The right and left pulmonary arteries are derived from which of the following embryological aortic arches?
Sixth aortic arch
16- During arch aortography, the vertebral artery would be seen to arise directly from which of the following?
Subclavian artery
17- 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?
Second part of duodenum
………………………………………………
Congenital Disorders:
. Pancreatic Divisum:
. Most common 3-10%
· Failure of fetal duct union.
· Congenital chronic pancreatitis.
. Cystic Fibrosis:
· CFTR gene mutation
- thick secretions.
. Annular Pancreas
· 2nd part duodenum obstruction.
· Ectopic Pancreas
· stomach and duodenum.
18- 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?
Weak ankle plantarfiexion; altered sensation on the sole of the foot; loss of ankle jerk reflex.
19- A surgeon makes a Pfannenstiel incision for access to the pelvic organs. He incises the abdominal wall down to and through the rectus sheath .- He retracts the rectus abdominis muscles laterally from the midline to expose the:
transversalis fascia
……………………………………….
In CS section the rectus muscle is not cut
Surgeons don’t cut muscle unless needed
Remember in thyroidectomy the strap muscles are not cut unless it’s needed
if required to be cut cut as high as possible to protect the innervation by the ansa cervicalis
this reminds us with the tracheostomy where the thyroid isthmus might require division unlike the cricothyrodotomy
20- 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
21- In an emergency situation what is the most appropriate surgical method of obtaining an airway?
Piercing the cricothyroid membrane
22- A.20-year-old man presents to the Emergency Department with a stab injury to the thenar eminence. On examination he is found to have a 2 cm long laceration with loss of sensation in the thumb and index finger and weakness: of the thenar muscles. Which of the following structures is most likely to have been injured?
Sensory and motor branches of median nerve
………………………………………………..
The thenar eminence is the mound formed at the base of the thumb on the palm of the hand by the intrinsic group of muscles of the thumb. The skin overlying this region is the area stimulated when trying to elicit a We palmomental reflex.
23- 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?
L1
Structures Crossed By
Transpyloric Plane :
L1 vertebra
Pylorus
Pancreatic neck
Duodenojejunal flexure
Fundus of gall bladder
9th costal cartilage
Hila of kidneys
Origin of portal vein
Transverse mesocolon
2nd part of duodenum
Superior mesenteric artery origin
Hilum of spleen
Termination of spinal cord
24- 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 ?
T8
25- 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?
Middle colic
In human anatomy, the marginal artery of the colon, also known as the marginal artery of Drummond : connects the inferior mesenteric artery with the superior mesenteric artery. It is sometimes absent, as an anatomical variant.
27- 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
Squint can occure due to 3rd 4th 6th cranial nerves
Here he is targeting the facialand trigeminal along with the abducense 6th cranial nerve
5678 at the pons
2244
Cerebrum 2
mid brain 2
pons 4
medulla 4
28- A 45-year-old woman presents with pain, swelling and stiffness affecting all her metacarpophalangeal joints. She has noticed weakness in her grip and her handwriting has changed. She is unable to extend her fingers fully. The index, middle and ring fingers in both hands show an ulnar deviation. The most Can likely diagnosis is:
rheumatoid arthritis
29- 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?
Intercostal artery
30- 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
31- 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)
32- 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
33- 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
34- 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
Anatomical site of the valves are not the same as the auscaltatory sites
38- The Cori cycle is important in lactate metabolism in the Septic surgical patient It is used to describe a pathway in which glucose is metabolised anaerobically to lactate in one tissue and the lactate is converted back to glucose in another; Which one of the following relies on this cycle to meet all of its energy needs?
Erythrocyte
40- 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?
Pelvic splanchnic nerves
41- A 73-year-old man with a history of irregular bowel movements presents with dysuria, pneumaturia and an Escherichia ccli urinary tract Infection. CT scans show a mass involving the sigmoid colon and the bladder. What is the commonest cause of this presentation?
Colonic diverticular disease
43- A 76-year-old woman falls and sustains an inter-trochanteric fractured neck of femur Following operative fixation her recovery is prolonged and she is discharged to a rehabilitation unit Six weeks after her original operation she is readmitted. She is drowsy, hypotensive and bradycardic. An ECG shows low voltage complexes and a prolonged QT interval Under-activity of which of the following glands gives the best explanation of the clinical picture?
Thyroid
Low voltage ecg in hypothyroidism
44- 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
45- 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
……………………………….
L1 & L2 - hip flexion
L3 & L4 - knee extension
L5 to S2 - knee flexion
L4- ankle dorsiflexion
S1 & S2 - plantarflexion
L5 - great toe extension
S2 & S3 - adduction toes
46- 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
……………………………………………………………
The Dorsum is the one you see when you look at your foot :D
49- 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
…………………………….
The conus medullaris (Latin for “medullary cone”) or conus terminalis is the tapered, lower end of the spinal cord. It occurs near lumbar vertebral levels 1 (L1) and 2 (L2), occasionally lower. … After the spinal cord tapers out, the spinal nerves continue to branch out diagonally, forming the cauda equina
50- 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 Pudendal nerve s234 keep the poo of the floor it’s responsible for incontence but not erection which was nervi ergintis splanchnic nerves
51- 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
52- A 35-year-old man presents with a three-week history of low back pain and a threeday 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
56- 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
57- 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
55- 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
58- 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
59- 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
60- 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
Bitemporatl Hemianopia = Optic CHiasma
Homonymous hemianopia = optic radiation
61- 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 hour 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
1st key in this stem is the lucid interval exclusive for the extradural hemorrhage
The 2nd key eye affected on the same side of the brain insult
62- 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
………………………………………
ACA stroke:
· Paralysis of contralateral foot ralateral toot
. Sensory loss over toes, foot and leg
. Impairment of gait and stance Abulia (slowness and prolonged delays to perform acts)
. Flat affect, lack of spontaneity, slowness, distractibility
· Cognitive impairment, such as perseveration and amnesia
· Urinary incontinence
63- 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
………………………………………..
MMA commonly injured at pterion Branch from Maxillary artery which is divided by the lateral ptergoid which function to open the mandible
The maxillary is branching from the erxternal carotid
The internal carotid doesn’t has any extracranial branches
The 1st branch of the internal carotid is the ophthalmic artery which is within the optic canal with the optic nerve
While the ophthalmic nerve within the cavernous sinus