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.
