Anatomy Flashcards
During a right hemicolectomy the caecum is mobilised. As the bowel is retracted medially a vessel is injured, posterior to the colon. Which of the following is the most likely vessel?
Right colic artery Inferior vena cava Aorta External iliac artery Gonadal vessels
Gonadal vessels
The key in this question is that its during the caecal mobilization. The gonadal vessels and ureter are important posterior relations that are at risk during a right hemicolectomy. During latter stages of the procedure, the ileocolic artery and vein are traced along the anterior aspect of the duodenum. At this point it is possible to injure these, the superior mesenteric vein or the middle colic vein, injury to any of these can result in torrential bleeding that is very difficult to control.
Cacum
Location
Proximal right colon below the ileocaecal valve
Intraperitoneal
Posterior relations Psoas Iliacus Femoral nerve Genitofemoral nerve Gonadal vessels
Anterior relations
Greater omentum
Arterial supply
Ileocolic artery
Lymphatic drainage
Mesenteric nodes accompany the venous drainage
The caecum is the most distensible part of the colon and in complete large bowel obstruction with a competent ileocaecal valve the most likely site of eventual perforation.
Which of the following forms the floor of the anatomical snuffbox?
Radial artery Cephalic vein Extensor pollicis brevis Scaphoid bone Cutaneous branch of the radial nerve
Scaphoid bone
The scaphoid bone forms the floor of the anatomical snuffbox. The cutaneous branch of the radial nerve is much more superficially and proximally located.
Which of the following structures suspends the spinal cord in the dural sheath?
Filum terminale Conus medullaris Ligamentum flavum Denticulate ligaments Anterior longitudinal ligament
Denticulate ligaments
The spinal cord is approximately 45cm in men and 43cm in women. The denticulate ligament is a continuation of the pia mater (innermost covering of the spinal cord) which has intermittent lateral projections attaching the spinal cord to the dura mater.
A 35 year old man falls and sustains a fracture to the medial third of his clavicle. Which vessel is at greatest risk of injury?
Subclavian vein Subclavian artery External carotid artery Internal carotid artery Vertebral artery
Subclavian vein
The subclavian vein lies behind subclavius and the medial part of the clavicle. It rests on the first rib, below and in front of the third part of the subclavian artery, and then on scalenus anterior which separates it from the second part of the artery (posteriorly).
A 17 year old lady presents with right iliac fossa pain and diagnosed as having acute appendicitis. You take her to theatre to perform a laparoscopic appendicectomy. During the procedure the scrub nurse distracts you and you inadvertently avulse the appendicular artery. The ensuing haemorrhage is likely to be supplied directly from which vessel?
Inferior mesenteric artery Superior mesenteric artery Ileo-colic artery Internal iliac artery None of the above
Ileo-colic artery
The appendicular artery is a branch of the ileocolic artery.
Which of the following structures attaches periosteum to bone?
Sharpey's fibres Peripheral lamellae Elastic fibres Fibrolamellar bundles Purkinje fibres
Sharpey’s 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.
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?
Popliteal artery Popliteal vein Common peroneal nerve Tibial nerve Small saphenous vein
Common peroneal nerve
The contents of the popliteal fossa are (from medial to lateral): Popliteal artery Popliteal vein Tibial nerve Common peroneal nerve
The sural nerve is a branch of the tibial nerve and usually arises at the inferior aspect of the popliteal fossa. However, its anatomy is variable.
An 18 year old man is stabbed in the neck and has to undergo repair of a laceration to the internal carotid artery. Post operatively he is noted to have a Horners syndrome. Which of the following will not be present?
Apparent enopthalmos Loss of sweating on the entire ipsilateral side of the face Constricted pupil Mild ptosis Normal sympathetic activity in the torso
Loss of sweating on the entire ipsilateral side of the face
The anhidrosis will be mild as this is a distal lesion and at worst only a very limited area of the ipsilateral face will be anhidrotic.
Which of the structures listed below accompanies the aorta as it traverses the aortic hiatus?
Oesophagus Thoracic duct Vagal trunks Right phrenic nerve Left phrenic nerve
Thoracic duct
The aorta is accompanied by the thoracic duct as it traverses the aortic hiatus. The vagal trunks accompany the oesophagus which passes through the muscular part of the diaphragm on the right. The right phrenic nerve accompanies the IVC as it passes through the caval opening. The left phrenic nerve passes through the muscular part of the diaphragm anterior to the central tendon on the left.
A 32 year old attends neurology clinic complaining of tingling in his hand. He has radial deviation of his wrist and there is mild clawing of his fingers, with the 4th and 5th digits being relatively spared. What is the most likely lesion?
Ulnar nerve damage at the wrist Ulnar nerve damage at the elbow Radial nerve damage at the elbow Median nerve damage at the wrist Median nerve damage at the elbow
Ulnar nerve damage at the elbow
The ulnar paradox- the higher the lesion, the less the clawing of the fingers seen clinically.
At the elbow the ulnar nerve lesion affects the flexor carpi ulnaris and flexor digitorum profundus.
An 8 year old boy falls onto an outstretched hand and sustains a supracondylar fracture. In addition to a weak radial pulse the child is noted to have loss of pronation of the affected hand. Which nerve is compromised?
Median Radial Ulnar Musculocutaneous Axillary
Median Nerve
This is a common injury in children. In this case the angulation and displacement have resulted in median nerve injury.
A 23 year old man undergoes an orchidectomy. The right testicular vein is ligated; into which structure does it drain?
Right renal vein Inferior vena cava Common iliac vein Internal iliac vein External iliac vein
Inferior vena cava
The testicular venous drainage begins in the septa and these veins together with those of the tunica vasculosa converge on the posterior border of the testis as the pampiniform plexus. The pampiniform plexus drains to the testicular vein.
The left testicular vein drains into the left renal vein.
The right testicular vein drains into the inferior vena cava.
What is the arterial blood supply to the lacrimal apparatus?
Nasociliary artery Supra orbital artery Internal carotid artery Ophthalmic artery Supra trochlear artery
Ophthalmic artery
The superior aspect of the vagina drains to which of the following lymph node groups?
Superficial inguinal nodes Para-aortic nodes Iliac nodes Meso rectal nodes Obturator nodes
liac nodes
Superior aspect = internal and external iliac nodes
Inferior aspect = Superficial inguinal nodes
A 35 year old farm labourer injures the posterior aspect of his hand with a mechanical scythe. He severs some of his extensor tendons in this injury. How many tunnels lie in the extensor retinaculum that transmit the tendons of the extensor muscles?
One Three Four Five Six
six
There are six tunnels, each lined by its own synovial sheath.
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?
Sciatic nerve damage L5 radiculopathy Inferior gluteal nerve damage Previous poliomyelitis Superior gluteal nerve damage
Superior gluteal nerve damage
This patient has a trendelenburg gait caused by damage to the superior gluteal nerve causing weakness of the abductor muscles. Classically a patient is asked to stand on one leg and the pelvis dips on the opposite side. The absence of a foot drop excludes the possibility of polio or L5 radiculopathy.
Which of the following nerve roots contribute nerve fibres to the ansa cervicalis?
C1 only C1, C2 and C3 C2, C3 and C6 C2, C4 and C5 C4, C5 and C6
C1, C2, C3
The ansa cervicalis is composed of a superior and inferior root, derived from C1, C2 and C3.
A 42 year old woman is admitted to the vascular ward for an endarterectomy. Her CT report confirms a left temporal lobe infarct. What is the most likely visual defect to be encountered?
Right homonymous hemianopia Right superior quadranopia Right inferior quadranopia Left superior quadranopia Left homonymous hemianopia
Right superior quadranopia
Temporal lesions cause a contralateral superior quadranopia. Think temporal area is at the top of the head i.e. superior quadranopia.
Which of the following is not contained within the deep posterior compartment of the lower leg?
Tibialis posterior muscle Posterior tibial artery Tibial nerve Sural nerve Flexor hallucis longus
Sural Nerves
The deep posterior compartment lies anterior to soleus. The sural nerve is superficially sited and therefore not contained within it.
An 18 year old man develops a severe spreading sepsis of the hand. The palm is explored surgically and the flexor digiti minimi brevis muscle is mobilised to facilitate drainage of the infection. Which of the following structures is not closely related to this muscle?
The hook of hamate Median nerve Superficial palmar arterial arch Digital nerves arising from the ulnar nerve None of the above
Median nerve
The flexor digiti minimi brevis originates from the Hamate, on its under- surface lie the ulnar contribution to the superficial palmar arterial arch and digital nerves derived from the ulnar nerve. The median nerve overlies the flexor tendons.
Which of the following does not exit the pelvis through the greater sciatic foramen?
Superior gluteal artery Internal pudendal vessels Sciatic nerve Obturator nerve Inferior gluteal nerve
Obturator nerve
The obturator nerve exits through the obturator foramen.
Which of the following carpal bones is a sesamoid bone in the tendon of flexor carpi ulnaris?
Triquetrum Lunate Pisiform Scaphoid Capitate
Pisiform
At which level is the hilum of the left kidney located?
L1 L2 T12 T11 L3
Remember L1 (‘left one’) is the level of the hilum of the left kidney
An 18 year old man undergoes a tonsillectomy for attacks of recurrent acute tonsillitis. Whilst in recovery he develops a post operative haemorrhage. Which of the following vessels is the most likely culprit?
Facial vein External palatine vein External carotid artery Internal jugular vein None of the above
External palatine vein
The external palatine vein lies immediately lateral to the tonsil and if damaged may be a cause of reactionary haemorrhage following tonsillectomy.
A 33 year old man develops a complex tibial and associated fibular fracture that is managed in a cast for 6 weeks. On removal of the cast the patient is noted to have a foot drop. Which nerve is most likely to be compromised?
Obturator Sciatic Tibial Common peroneal Medial plantar
Common peroneal
The cast is most likely to affect the common peroneal nerve as it wraps around the fibular head. A foot drop is the typical end result of such an injury.
Which of the following statements relating to the basilar artery and its branches is false?
The superior cerebellar artery may be decompressed to treat trigeminal neuralgia
Occlusion of the posterior cerebral artery causes contralateral loss of the visual field
The oculomotor nerve lies between the superior cerebellar and posterior cerebral arteries
The posterior inferior cerebellar artery is the largest of the cerebellar arteries arising from the basilar artery
The labyrinthine branch is accompanied by the facial nerve
The posterior inferior cerebellar artery is the largest of the cerebellar arteries arising from the basilar artery
The posterior inferior cerebellar artery is the largest of the cerebellar arteries arising from the vertebral artery. The labyrinthine artery is long and slender and may arise from the lower part of the basilar artery. It accompanies the facial and vestibulocochlear nerves into the internal auditory meatus. The posterior cerebral artery is often larger than the superior cerebellar artery and it is separated from the vessel, near it’s origin, by the oculomotor nerve. Arterial decompression is a well established therapy for trigeminal neuralgia.
A 34 year old lady undergoes a thyroidectomy for Graves disease. Post operatively she develops a tense haematoma in the neck. In which of the following fascial planes will it be contained?
Gerotas fascia Waldeyers fascia Pretracheal fascia Sibsons fascia Clavipectoral fascia
Pretracheal fascia
The pretracheal fascia encloses the thyroid and is unyielding. Therefore tense haematomas can develop.
A 22 year old man suffers a compound fracture of the tibia. During attempted surgical repair the deep peroneal nerve is divided. Which of the following muscles will not be affected as a result?
Tibialis anterior Peroneus longus Extensor hallucis longus Extensor digitorum longus Peroneus tertius
Peroneus longus
Which of the following nerves is responsible for the motor innervation of the sternocleidomastoid muscle?
Ansa cervicalis Accessory nerve Hypoglossal nerve Facial nerve Vagus nerve
Accessory nerve
The motor supply to the sternocleidomastoid is from the accessory nerve. The ansa cervicalis supplies sensory information from the muscle.
Anatomy
Origin
Rounded tendon attached to upper manubrium sterni and muscular head attached to medial third of the clavicle
Insertion
Mastoid process of the temporal bone and lateral area of the superior nuchal line of the occipital bone
Innervation
Spinal part of accessory nerve and anterior rami of C2 and C3 (proprioception)
Action
Both: extend the head at atlanto-occipital joint and flex the cervical vertebral column. Accessory muscles of inspiration.
Single: lateral flexion of neck, rotates head so face looks upward to the opposite side
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?
Ligamentum flavum Denticulate ligament Dural sheath Pia Mater Supraspinous ligament
Supraspinous ligament
Lumbar punctures are performed to obtain cerebrospinal fluid. In adults, the procedure is best performed at the level of L3/L4 or L4/5 interspace. These regions are below the termination of the spinal cord at L1.
During the procedure the needle passes through:
The supraspinous ligament which connects the tips of spinous processes and the interspinous ligaments between adjacent borders of spinous processes
Then the needle passes through the ligamentum flavum, which may cause a give as it is penetrated
A second give represents penetration of the needle through the dura mater into the subarachnoid space. Clear CSF should be obtained at this point
A 22 year old man presents with appendicitis. At operation the appendix is retrocaecal and difficult to access. Division of which of the following anatomical structures should be undertaken?
Ileocolic artery Mesentery of the caecum Gonadal vessels Lateral peritoneal attachments of the caecum Right colic artery
Lateral peritoneal attachments of the caecum
The commonest appendiceal location is retrocaecal. Those struggling to find it at operation should trace the tenia to the caecal pole where the appendix is located. If it cannot be mobilised easily then division of the lateral caecal peritoneal attachments (as for a right hemicolectomy) will allow caecal mobilisation and facilitate the procedure.
How many unpaired branches leave the abdominal aorta to supply the abdominal viscera?
One Two Three Four Five
Three
There are three unpaired branches to the abdominal viscera. These include the coeliac axis, the SMA and IMA. Branches to the adrenals, renal arteries and gonadal vessels are paired. The fourth unpaired branch of the abdominal aorta, the median sacral artery, does not directly supply the abdominal viscera.
Which of the following nerves supplies the majority of the skin on the palmar aspect of the thumb?
Ulnar Median Radial Musculocutaneous None of the above
Median
Which of the muscles listed below is attached to the anterior aspect of the fibrous capsule that encases the elbow joint?
Pronator teres Biceps Brachialis Triceps Extensor carpi radialis longus
Brachialis
The brachialis inserts some of its fibres into the fibrous joint of the elbow capsule and when it contracts, it helps to flex the joint.
A 66 year old man with peripheral vascular disease is undergoing a below knee amputation. In which of the lower leg compartments does peroneus brevis lie?
Lateral compartment Anterior compartment Superficial posterior compartment Deep posterior compartment None of the above
Lateral compartment
The interosseous membrane separates the anterior and posterior compartments. The deep and superficial compartments are separated by the deep transverse fascia. The peroneus brevis is part of the lateral compartment.
What is the nerve root value of the external urethral sphincter?
S4 S1, S2, S3 S2, S3, S4 L3, L4, L5 L5, S1, S2
S2, S3, S4
The external urethral sphincter is innervated by branches of the pudendal nerve, therefore the root values are S2, S3, S4.
A 34 year old man with a submandibular gland stone is undergoing excision of the submandibular gland. The incision is sited transversely approximately 4cm below the mandible. After incising the skin, platysma and deep fascia which of the following structures is most likely to be encountered.
Facial artery Facial vein Lingual nerve Hypoglossal nerve Glossopharyngeal nerve
Facial vein
When approaching the submandibular gland the facial vein and submandibular lymph nodes are the most superficially encountered structures. Each sub mandibular gland has a superficial and deep part, separated by the mylohyoid muscle. The facial artery passes in a groove on the superficial aspect of the gland. It then emerges onto the surface of the face by passing between the gland and the mandible. The facial vein is encountered first in this surgical approach because the incision is made 4cm below the mandible (to avoid injury to the marginal mandibular nerve).
Which of the following structures are not closely related to the adductor longus muscle?
Long saphenous vein Tendon of iliacus The profunda branch of the femoral artery Pectineus muscle Femoral nerve
Tendon of iliacus
Femoral triangle:
Adductor longus medially
Inguinal ligament superiorly
Sartorius muscle laterally
Adductor longus forms the medial border of the femoral triangle. It is closely related to the long saphenous vein which overlies it and the profunda branch of the femoral artery. The femoral nerve is related to it inferiorly. However, the tendon of iliacus inserts proximally and is not in contact with adductor longus.
Which of the following structures passes through the quadrangular space near the humeral head?
Axillary artery Radial nerve Axillary nerve Median nerve Transverse scapular artery
Axillary nerve
The quadrangular space is bordered by the humerus laterally, subscapularis and teres minor superiorly, teres major inferiorly and the long head of triceps medially. It lies lateral to the triangular space. It transmits the axillary nerve and posterior circumflex humeral artery.
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?
Glossopharyngeal Greater petrosal Olfactory Trigeminal Chorda tympani
Chorda tympani
The chorda tympani branch of the facial nerve passes forwards through itrs canaliculus into the middle ear, and crosses the medial aspect of the tympanic membrane. It then passes antero-inferiorly in the infratemporal fossa. It distributes taste fibres to the anterior two thirds of the tongue.
Through which of the structures listed below does the axillary nerve pass?
Quadrangular space Triangular space Subclavicular space Sub pectoral space Intercostal space
Quadrangular space
Axillary nerve passes through the quadrangular space
Which of the following statements relating to the knee joint is false?
It is the largest synovial joint in the body
When the knee is fully extended all ligaments (bar the anterolateral aspect of the posterior cruciate ligament) of the knee joint are taut
Rupture of the anterior cruciate ligament may result in haemarthrosis
The posterior aspect of the patella is extrasynovial
The joint is innervated by the femoral, sciatic and obturator nerves
The posterior aspect of the patella is extrasynovial
The posterior aspect is intrasynovial and the knee itself comprises the largest synovial joint in the body. It may swell considerably following trauma such as ACL injury. Which may be extremely painful owing to rich innervation from femoral, sciatic and ( a smaller) contribution from the obturator nerve. During full extension all ligaments are taut and the knee is locked.
