9- Mixed Anatomy (1)MSQs Only Flashcards
1 of 610
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.
2 of 610
Which of the following structures separates the posterior cruciate ligament from the popliteal artery?
.
Oblique popliteal ligament
The posterior cruciate ligament is separated from the popliteal vessels at its origin by the oblique popliteal ligament.It is attached above to the upper margin of the intercondyloid fossa and posterior surface of the femur close to the articular margins of the condyles, and below to the posterior margin of the head of the tibia. The transverse ligament is located anteriorly
3 of 610
Which muscle is supplied by the superficial peroneal nerve?
Peroneus brevis
6 of 610
Which of the structures listed below lies posterior to the carotid sheath at the level of the 6th cervical vertebra?
Cervical sympathetic chain
The carotid sheath is crossed anteriorly by the hypoglossal nerves and the ansa cervicalis. The vagus lies within it. The cervical sympathetic chain lies posteriorly between the sheath and the prevertebral fascia.
4 of 610
A 25 year old man sustains a severe middle cranial fossa basal skull fracture. Once he has recovered it is noticed that he has impaired tear secretion. This is most likely to be the result of damage to which of the following?
Greater petrosal nerve
The greater petrosal nerve may be injured and carries fibres for lacrimation
5 of 610
Which of the following is true in relation to the sartorius muscle?
Forms the Pes anserinus with Gracilis and semitendinous muscle
It is innervated by the superficial branch of the femoral nerve. It is a component of the pes anserinus.
10 of 610
Which of the structures listed below overlies the cephalic vein?
Extensor retinaculum
Bicipital aponeurosis
Biceps muscle
Antebrachial fascia
None of the above(Right)
…………………………………………………
The cephalic vein is superficially located in the upper limb and overlies most the fascial planes. It pierces the coracoid membrane (continuation of the clavipectoral fascia) to terminate in the axillary vein. It lies anterolaterally to biceps.
7 of 610
Which of the following are not generally supplied by the right coronary artery?
The sino atrial node
The circumflex artery( Right)
The atrioventricular node
Most of the right ventricle
The right atrium
………………………………….
The circumflex artery is generally a branch of the left coronary artery.
9 of 610
Which of the following statements relating to the right phrenic nerve is false?
It lies deep to the prevertebral layer of deep cervical fascia
Crosses posterior to the 2nd part of the subclavian artery( Right)
It runs on the anterior surface of the anterior scalene muscle
On the right side it leaves the mediastinum via the vena cava hiatus at a level of T8
The right phrenic nerve passes over the right atrium
8 of 610
Which of the following statements relating to the root of the neck is false?
The lung projects into the neck beyond the first rib and is constrained by Sibson’s fascia
The subclavian artery arches over the first rib anterior to scalenus anterior(Right)
The trunks of the brachial plexus lie posterior to the subclavian artery on the first rib
The roots and trunks of the Brachial plexus lie between scalenus anterior and scalenus medius muscles
The thyrocervical trunk is a branch of the subclavian artery
……………………………………………
The subclavian artery lies posterior to scalenus anterior, the vein lies in front. Sibson’s fascia is another name for the suprapleural membrane.
11 of 610
A young child undergoes a difficult craniotomy for fulminant mastoiditis and associated abscess. During the procedure the trigeminal nerve is severely damaged within Meckels cave. Which deficit is least likely to be present?
Anaesthesia over the ipsilateral anterior aspect of the scalp
Loss of the corneal reflex
Weakness of the ipsilateral masseter muscle
Anaesthesia of the anterior aspect of the lip
Anaesthesia over the entire ipsilateral side of the face(Right)
………………………………………….
The angle of the jaw is not innervated by sensory fibres of the trigeminal nerve and is spared in this type of injury.
Remember the trigeminal nerve provides motor innervation to the muscles of mastication. The close proximity of the site of injury to the motor fibres is likely to result in at least some compromise of motor muscle function.
12 of 610
A 53 year old man with a carcinoma of the lower third of the oesophagus is undergoing an oesophagogastrectomy. As the surgeons mobilise the mid part of the oesophagus, where are they most likely to encounter the thoracic duct?
Posterior to the oesophagus
The thoracic duct lies posterior to the oesophagus and passes to the left at the level of the Angle of Louis. It exits the thorax at T12 together with the aorta.
13 of 610
A 44 year old lady is recovering following a transphenoidal hypophysectomy. Unfortunately there is a post operative haemorrhage. Which of the following features is most likely to occur initially?
Bi-temporal hemianopia
The pituitary is covered by a sheath of dura and an expanding haematoma at this site may compress the optic chiasm in the same manner as an expanding pituitary tumour.
14 of 610
Which nerve directly innervates the sinoatrial node?
Superior cardiac nerve
Right vagus nerve
Left vagus nerve
Inferior cardiac nerve
None of the above( Right)
………………………………………..
No single one of the above nerves is responsible for direct cardiac innervation (which those who have handled the heart surgically will appreciate).
The heart receives its nerves from the superficial and deep cardiac plexuses. The cardiac plexuses send small branches to the heart along the major vessels, continuing with the right and left coronary arteries. The vagal efferent fibres emerge from the brainstem in the roots of the vagus and accessory nerves, and run to ganglia in the cardiac plexuses and within the heart itself.
The background vagal discharge serves to limit heart rate, and loss of this background vagal tone accounts for the higher resting heart rate seen following cardiac transplant.
15 of 610
Which of the following is not contained within the middle mediastinum?
Main bronchi
Arch of the azygos vein
Thoracic duct(Right)
Pericardium
Aortic root
16 of 610
An injury to the spinal accessory nerve will have the greatest effect on which of the following movements?
Upward rotation of the scapula
The spinal accessory nerve innervates trapezius. The entire muscle will retract the scapula. However, its upper and lower fibres act together to upwardly rotate it.
8 of 610
Which of the following statements relating to the root of the neck is false?
The lung projects into the neck beyond the first rib and is constrained by Sibson’s fascia
The subclavian artery arches over the first rib anterior to scalenus anterior( Right)
The trunks of the brachial plexus lie posterior to the subclavian artery on the first rib
The roots and trunks of the Brachial plexus lie between scalenus anterior and scalenus medius muscles
The thyrocervical trunk is a branch of the subclavian artery
………………………………………….
The subclavian artery lies posterior to scalenus anterior, the vein lies in front. Sibson’s fascia is another name for the suprapleural membrane.
18 of 610
Which cranial nerve provides general sensation to the anterior two thirds of the tongue?
Trigeminal
Taste to the anterior two thirds of the tongue is supplied by the facial nerve, the trigeminal supplies general sensation, this is mediated by the mandibular branch of the trigeminal nerve (via the lingual nerve)
17 of 610
Which of the following is not closely related to the capitate bone?
Lunate bone
Scaphoid bone
Ulnar nerve( Right)
Hamate bone
Trapezoid bone
……………………………………………
The ulnar nerve and artery lie adjacent to the pisiform bone. The capitate bone articulates with the lunate, scaphoid, hamate and trapezoid bones, which are therefore closely related to it.
20 of 610
A 49 year old man undergoes a low anterior resection for cancer. 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 nervi erigentes
The penis takes autonomic nerves from the nervi erigentes that lie near the seminal vesicles. These may be compromised by direct surgical trauma (such as use of diathermy in this area) and also by radiotherapy that is used in these patients pre operatively. The result is that up to 50% of patients may develop impotence following rectal cancer surgery.
19 of 610
A 23 year old man is admitted with a suspected ureteric colic. A KUB style x-ray is obtained. In which of the following locations is the stone most likely to be visualised?
The tips of the transverse processes between L2 and L5
The ureter lies anterior to L2 to L5 and stones may be visualised at these points, they may also be identified over the sacro-iliac joints
22 of 610
A 25 year old man undergoes an excision of a pelvic chondrosarcoma, during the operation the obturator nerve is sacrificed. Which of the following muscles is least likely to be affected as a result?
Sartorius
Sartorius is supplied by the femoral nerve. In approximately 20% of the population, pectineus is supplied by the accessory obturator nerve. Adductor magnus has a composite supply from the obturator and sciatic nerves.
23 of 610
A 17 year old male has a suspected testicular torsion and the scrotum is to be explored surgically. The surgeon incises the skin and then the dartos muscle. What is the next tissue layer that will be encountered during the dissection?
External spermatic fascia
The layers that will be encountered are
1. Skin
2. Dartos fascia and muscle
3. External spermatic fascia
4. Cremasteric muscle and fascia
5. Internal spermatic fascia
6. Parietal layer of the tunica vaginalis
The layers of the spermatic cord and scrotum are a popular topic in the MRCS exam.
A mnemonic which may help:
Some Damned Examiner Called It The Testes (skin dartos external fascia cremaster internal fascia tunica Testes)
21 of 610
Into which of the following structures does the superior part of the fibrous capsule of the shoulder joint insert?
The anatomical neck of the humerus
The shoulder joint is a shallow joint, hence its great mobility. However, this comes at the expense of stability. The fibrous capsule attaches to the anatomical neck superiorly and the surgical neck inferiorly