anatomy 18.04 part 2 Flashcards
A 73 year old man develops a lesion affecting the lobule of his ear. Into which of the following lymph node groups will the lesion drain?
Deep cervical
Superficial cervical
Retroauricular nodes
Occipital nodes
Internal jugular nodes
The lobule of the ear drains to the superficial cervical nodes.
The lateral surface of the upper half drains to the superficial parotid lymph nodes
The cranial surface of the superior half drains to the mastoid nodes and deep cervical lymph nodes
The lower half and lobule drain into the superficial cervical lymph nodes.
Which of the following options in relation to the liver is true?
Ligamentum venosum is an anterior relation of the liver
The portal triad comprises the hepatic artery, hepatic vein and tributary of the bile duct
The liver is completely covered by peritoneum
There are no nerves within the porta hepatis
The caudate lobe is superior to the porta hepatis
‘VC goes with VC’
The ligamentun Venosum and Caudate is on same side as Vena Cava [posterior].
Ligamentum venosum is posterior to the liver. The portal triad contains the portal vein rather than the hepatic vein. There is the ‘bare area of the liver’ created by a void due to the coronary ligament layers being widely separated. There are sympathetic and parasympathetic nerves in the porta hepatis.
A surgical resection specimen is analysed histologically. The pathologist comments that at the periphery of the resected specimen, oxyphil cells are identified. In which of the structures listed below are these cells typically found?
Thymus
Thyroid gland
Parathyroid gland
Lymph node
Adrenal gland
Oxyphil cells are typically found in parathyroid glands
Which of the following statements relating to the right phrenic nerve is false?
It lies superficial to the prevertebral layer of deep cervical fascia
Crosses posterior to the 2nd part of the subclavian artery
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
The question asks which statement is false. The phrenic nerve descends on scalenus anterior posterolateral to the IJV and passing anterior to the cervical pleura and the second part of the subclavian artery, behind the subclavian vein. The question branch stated that the nerve passed posterior to the artery (which is false) and this is therefore the correct answer.
How many compartments are there in the lower leg?
2
1
3
5
4
The posterior compartment of the lower leg has both superficial and deep posterior layers, together with the anterior and lateral compartments this allows for four compartments. Decompression of the deep posterior compartment during fasciotomy may be overlooked with significant sequelae.
Which of the following structures is not closely related to the posterior tibial artery?
Soleus posteriorly
Tibial nerve laterally
Deep peroneal nerve laterally
Flexor hallucis longus postero-inferiorly
Popliteus
The deep peroneal nerve lies in the anterior compartment. The tibial nerve lies medially. At its termination it lies deep to the flexor retinaculum. The tibial nerve lies medial to the popliteal vessels but lateral to the posterior tibial artery.
Which of the following represents the root values of the sciatic nerve?
L4 to S3
L1 to L4
L3 to S1
S1 to S4
L5 to S1
The sciatic nerve most commonly arises from L4 to S3.
The following statements relating to the ankle joint are true except?
Three groups of ligaments provide mechanical stability
The sural nerve lies medial to the Achilles tendon at its point of insertion
Eversion of the foot occurs at the sub talar joint
The flexor hallucis longus tendon is the most posterior structure at the medial malleolus
The saphenous nerve crosses the ankle joint.
The sural nerve lies behind the distal fibula. Inversion and eversion are sub talar movements. The structures passing behind the medial malleolus from anterior to posterior include: tibialis posterior, flexor digitorum longus, posterior tibial vein, posterior tibial artery, nerve, flexor hallucis longus.
Which of the following is not contained within the middle mediastinum?
Main bronchi
Arch of the azygos vein
Thoracic duct
Pericardium
Aortic root
The thoracic duct lies within the posterior and superior mediastinum.
A 23 year old lady with sialolithiasis of the submandibular gland is undergoing excision of the gland. Which of the following nerves is at risk as the duct is mobilised?
Lingual nerve
Buccal nerve
Facial nerve
Glossopharyngeal
Vagus
The lingual nerve wraps around Whartons duct. The lingual nerve provides sensory supply to the anterior 2/3 of the tongue.
Which of the following is not a content of the anterior triangle of the neck?
Vagus nerve
Submandibular gland
Phrenic nerve
Internal jugular vein
Hypoglossal nerve
The phrenic nerve is a content of the posterior triangle. The anterior triangle contains the carotid sheath and its contents.
A 53 year old man is undergoing a left hemicolectomy for carcinoma of the descending colon. From which embryological structure is this region of the gastrointestinal tract derived?
Vitellino-intestinal duct
Hind gut
Mid gut
Fore gut
Woolffian duct
The left colon is embryologically part of the hind gut. Which accounts for its separate blood supply via the IMA.
A 56 year old man is left impotent following an abdomino-perineal excision of the colon and rectum. What is the most likely explanation?
Psychosexual issues related to an end colostomy
Damage to the sacral venous plexus during total mesorectal excision
Damage to the left ureter during sigmoid mobilisation
Damage to the hypogastric plexus during mobilisation of the inferior mesenteric artery
Damage to the internal iliac artery during total mesorectal excision
Autonomic nerve injury is the most common cause.
A 59 year old man is undergoing an extended right hemicolectomy for a carcinoma of the splenic flexure of the colon. The surgeons divide the middle colic vein close to its origin. Into which of the following structures does this vessel primarily drain?
Superior mesenteric vein
Portal vein
Inferior mesenteric vein
Inferior vena cava
Ileocolic vein
The middle colonic vein drains into the SMV, if avulsed during mobilisation then dramatic haemorrhage can occur and be difficult to control.
A 22 year old man sustains a blow to the side of his head with a baseball bat during a fight. He is initially conscious. However, he subsequently loses consciousness and then dies. Post mortem examination shows an extradural haematoma. The most likely culprit vessel is a branch of which of the following?
Middle cerebral artery
Internal carotid artery
Anterior cerebral artery
Maxillary artery
Mandibular artery
The middle meningeal artery is the most likely source of the extradural haematoma in this setting. It is a branch of the maxillary artery. The middle cerebral artery does not give rise to the middle meningeal artery. Note that the question is asking for the vessel which gives rise to the middle meningeal artery (‘the likely culprit vessel is a branch of which of the following’)
A 56 year old lady is due to undergo a left hemicolectomy for carcinoma of the splenic flexure. The surgeons decide to perform a high ligation of the inferior mesenteric vein. Into which of the following does this structure usually drain?
Portal vein
Inferior vena cava
Left renal vein
Left iliac vein
Splenic vein
Beware of ureteric injury in colonic surgery.
The inferior mesenteric vein drains into the splenic vein, this point of union lies close to the duodenum and this surgical maneouvre is a recognised cause of ileus.
A 22 year old falls over and lands on a shard of glass. It penetrates the palmar aspect of his hand, immediately lateral to the pisiform bone. Which of the following structures is most likely to be injured?
Palmar cutaneous branch of the median nerve
Lateral tendons of flexor digitorum superficialis
Ulnar artery
Flexor carpi radialis tendons
Lateral tendons of flexor digitorum profundus
The ulnar nerve and artery are at most immediate risk in this injury. This is illustrated in the image below:
Which of the following structures attaches periosteum to bone?
Sharpey’s fibres
Peripheral lamellae
Elastic fibres
Fibrolamellar bundles
Purkinje fibres
Periosteum is attached to bone by strong collagenous fibers called Sharpey’s fibres, which extend to the outer circumferential and interstitial lamellae. It also provides an attachment for muscles and tendons.
Which of the following muscles lies medial to the long thoracic nerve?
Serratus anterior
Latissimus dorsi
Coracobrachialis
Pectoralis minor
None of the above
Serratus anterior
A 62 year old man is undergoing a left hemicolectomy for carcinoma of the descending colon. The registrar commences mobilisation of the left colon by pulling downwards and medially. Blood soon appears in the left paracolic gutter. The most likely source of bleeding is the:
Marginal artery
Left testicular artery
Spleen
Left renal vein
None of the above
The spleen is commonly torn by traction injuries in colonic surgery. The other structures are associated with bleeding during colonic surgery but would not manifest themselves as blood in the paracolic gutter prior to incision of the paracolonic peritoneal edge.
A 73 year old man undergoes a sub total oesophagectomy with anastomosis of the stomach to the cervical oesophagus. Which vessel will be primarily responsible for the arterial supply to the oesophageal portion of the anastomosis?
Superior thyroid artery
Internal carotid artery
Direct branches from the thoracic aorta
Inferior thyroid artery
Subclavian artery
The cervical oesophagus is supplied by the inferior thyroid artery. The thoracic oesophagus (removed in this case) is supplied by direct branches from the thoracic aorta.
Which structure separates the cephalic vein and the brachial artery in the antecubital fossa?
Brachioradialis muscle
Bicipital aponeurosis
Origin of flexor digitorum profundus muscle
Pronator quadratus muscle
Origin of flexor digitorum superficialis muscle
