Anatomy Mix

Question 1

Which of the following is not a content of the porta hepatis? A. Portal vein B. Hepatic artery C. Cystic duct D. Hepatic lymph nodes E. None of the above

Answer 1

The cystic duct lies outside the porta hepatis and is an important landmark in laparoscopic cholecystectomy. The structures in the porta hepatis are: Portal vein Hepatic artery Common hepatic duct

Question 2

Which of the following structures is not closely related to the carotid sheath? A. Sternothyroid muscle B. Sternohyoid muscle C. Hypoglossal nerve D. Superior belly of omohyoid muscle E. Anterior belly of digastric muscle

Answer 2

At its lower end the carotid sheath is related to sternohyoid and sternothyroid. Opposite the cricoid cartilage the sheath is crossed by the superior belly of omohyoid. Above this level the sheath is covered by the sternocleidomastoid muscle. Above the level of the hyoid the vessels pass deep to the posterior belly of digastric and stylohyoid. Opposite the hyoid bone the sheath is crossed obliquely by the hypoglossal nerve.

Question 3

A 21 year old develops tonsillitis. He is in considerable pain. Which of the following nerves is responsible for the sensory innervation of the tonsillar fossa? A. Facial nerve B. Trigeminal nerve C. Glossopharyngeal nerve D. Hypoglossal nerve E. Vagus

Answer 3

The glossopharyngeal nerve is the main sensory nerve for the tonsillar fossa. A lesser contribution is made by the lesser palatine nerve. Because of this otalgia may occur following tonsillectomy.

Question 4

A man has an incision sited than runs 8cm from the deltopectoral groove to the midline. Which of the following is not at risk of injury? A. Cephalic vein B. Shoulder joint capsule C. Axillary artery D. Pectoralis major E. Trunk of the brachial plexus

Answer 4

This region will typically lie medial to the joint capsule. The diagram below illustrates the plane that this would transect and as it can be appreciated the other structures are all at risk of injury

Question 5

A surgeon is due to perform a laparotomy for perforated duodenal ulcer. An upper midline incision is to be performed. Which of the following structures is the incision most likely to divide? A. Rectus abdominis muscle B. External oblique muscle C. Linea alba D. Internal oblique muscle E. None of the above

Answer 5

Linea AlbaUpper midline abdominal incisions will involve the division of the linea alba. Division of muscles will not usually improve access in this approach and they would not be routinely encountered during this incision.

Question 6

Question 6 of 328 A 59 year old man is undergoing an extended right hemicolectomy for a carcinoma of the hepatic flexure of the colon. The surgeons divide the middle colonic vein close to its origin. Into which of the following structures does this vessel primarily drain? A. Superior mesenteric vein B. Portal vein C. Inferior mesenteric vein D. Inferior vena cava E. Ileocolic vein

Answer 6

SMVThe middle colonic vein drains into the SMV, if avulsed during mobilisation then dramatic haemorrhage can occur and be difficult to control.

Question 7

Question 7-9 of 328 Theme: Nerve InjuryA. Median nerveB. Ulnar nerveC. Radial nerveD. Musculocutaneous nerveE. Axillary nerveF. Anterior interosseous nerveG. Posterior interosseous nerveFor each scenario please select the most likely underlying nerve injury. Each option may be used once, more than once or not at all.7. A 19 year old student is admitted to A&E after falling off a wall. He is unable to flex his index finger. An x-ray confirms a supracondylar fracture.8. A well toned weight lifter attends clinic reporting weakness of his left arm. There is weakness of flexion and supination of the forearm.9. An 18 year old girl sustains an Holstein-Lewis fracture. Which nerve is at risk?

Answer 7

7. A 19 year old student is admitted to A&E after falling off a wall. He is unable to flex his index finger. An x-ray confirms a supracondylar fracture.You answered Radial nerveThe correct answer is Median nerveThis median nerve is at risk during a supracondylar fracture.8. A well toned weight lifter attends clinic reporting weakness of his left arm. There is weakness of flexion and supination of the forearm.You answered Ulnar nerveThe correct answer is Musculocutaneous nerveMucocutaneous nerve compression due to entrapment of the nerve between biceps and brachialis. Elbow flexion and supination of the arm are affected. This is a rare isolated injury.9. An 18 year old girl sustains an Holstein-Lewis fracture. Which nerve is at risk?Radial nerveProximal lesions affect the triceps. Also paralysis of wrist extensors and forearm supinators occur. Reduced sensation of dorsoradial aspect of hand and dorsal 31/2 fingers. Holstein-Lewis fractures are fractures of the distal humerus with radial nerve entrapment.

Question 8

Question 10 of 328 A 35 year old farm labourer is 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? A. One B. Three C. Four D. Five E. Six

Answer 8

SIXThere are six tunnels, each lined by its own synovial sheath.

Question 9

Question 11 of 328 A 23 year old man is stabbed in the chest approximately 10cm below the right nipple. In the emergency department a abdominal ultrasound scan shows a large amount of intraperitoneal blood. Which of the following statements relating to the likely site of injury is untrue? A. Part of its posterior surface is devoid of peritoneum. B. The quadrate lobe is contained within the functional right lobe. C. Its nerve supply is from the coeliac plexus. D. The hepatic flexure of the colon lies posterio-inferiorly. E. The right kidney is closely related posteriorly.

Answer 9

The quadrate lobe is contained within the functional right lobeThe right lobe of the liver is the most likely site of injury. Therefore the answer is B as the quadrate lobe is functionally part of the left lobe of the liver. The liver is largely covered in peritoneum. Posteriorly there is an area devoid of peritoneum (the bare area of the liver). The right lobe of the liver has the largest bare area (ans is larger thant the left lobe).

Question 10

Question 12 of 328 A 22 year old man is involved in a fight and sustains a skull fracture with an injury to the middle meningeal artery. A craniotomy is performed, and with considerable difficulty the haemorrhage from the middle meningeal artery is controlled by ligating it close to its origin. What is the most likely sensory impairment that the patient may notice post operatively? A. Parasthesia of the ipsilateral external ear B. Loss of taste sensation from the anterior two thirds of the tongue C. Parasthesia overlying the angle of the jaw D. Loss of sensation from the ipsilateral side of the tongue E. Loss of taste from the posterior two thirds of the tongue

Answer 10

Parasthesia of the ipsilateral external earThe auriculotemporal nerve is closely related to the middle meningeal artery and may be damaged in this scenario. The nerve supplied sensation to the external ear and outermost part of the tympanic membrane. The angle of the jaw is innervated by C2,3 roots and would not be affected. The tongue is supplied by the glossopharyngeal nerve

Question 11

Question 13 of 328 A 72 year old man presents with haemoptysis and undergoes a bronchoscopy. The carina is noted to be widened. At which level does the trachea bifurcate? A. T3 B. T5 C. T7 D. T2 E. T8

Answer 11

T5The trachea bifurcates at the level of the fifth thoracic vertebra. Or the sixth in tall subjects.

Question 12

Question 14 of 328 A 23 year old man is injured during a game of rugby. He suffers a fracture of the distal third of his clavicle, it is a compound fracture and there is evidence of arterial haemorrhage. Which of the following vessels is most likely to be encountered first during subsequent surgical exploration? A. Posterior circumflex humeral artery B. Axillary artery C. Thoracoacromial artery D. Sub scapular artery E. Lateral thoracic artery

Answer 12

Thoracoacromial artery

Question 13

Question 15 of 328 The following are true of the femoral nerve, except: A. It is derived from L2, L3 and L4 nerve roots B. It supplies sartorius C. It supplies quadriceps femoris D. It gives cutaneous innervations via the saphenous nerve E. It supplies adductor longus

Answer 13

It supplies adductor longusAdductor longus is supplied by the obturator nerve.

Question 14

Question 16 of 328 Where is the vomiting centre located? A. Medulla oblongata B. Substantia nigra C. Antrum of stomach D. Pons E. Midbrain

Answer 14

Medulla oblongataABC’s of Non- GI causes of vomitingAcute renal failureBrain (Increased ICP)Cardiac (Inferior MI)DKAEars (labyrinthitis)Foreign substances (Tylenol, theo, etc)GlaucomaHyperemesis GravidarumInfections (pyelonephritis, meningitis)

Question 15

Which of the following nerves conveys sensory information from the laryngeal mucosa? A. Glossopharyngeal B. Laryngeal branches of the vagus C. Ansa cervicalis D. Laryngeal branches of the trigeminal E. None of the above

Answer 15

Laryngeal branches of the vagusThe laryngeal branches of the vagus supply sensory information from the larynx

Question 16

Question 18 of 328 Which of the following nerves passes through the greater sciatic foramen and innervates the perineum? A. Pudendal B. Sciatic C. Superior gluteal D. Inferior gluteal E. Posterior cutaneous nerve of the thigh

Answer 16

Pudendal3 divisions of the pudendal nerve: Rectal nerve Perineal nerve Dorsal nerve of penis/ clitorisAll these pass through the greater sciatic foramen.The pudendal nerve innervates the perineum. It passes between piriformis and coccygeus medial to the sciatic nerve.

Question 17

Question 19 of 328 Which of the following is true in relation to the sartorius muscle? A. Innervated by the deep branch of the femoral nerve B. Inserts at the fibula C. It is the shortest muscle in the body D. Forms the Pes anserinus with Gracilis and semitendinous muscle E. Causes extension of the knee

Answer 17

Forms the Pes anserinus with Gracilis and semitendinous muscleIt is innervated by the superficial branch of the femoral nerve. It is a component of the pes anserinus.

Question 18

Question 20-22 of 328 Theme: Nerve lesionsA. Sciatic nerveB. Peroneal nerveC. Tibial NerveD. Obturator nerveE. Ilioinguinal nerveF. Femoral nerveG. None of the abovePlease select the most likely nerve injury for the scenario given. Each option may be used once, more than once or not at all20. A 56 year old man undergoes a low anterior resection with legs in the Lloyd-Davies position. Post operatively he complains of foot drop.21. A 23 year old man complains of severe groin pain several weeks after a difficult inguinal hernia repair.22. A 72 year old man develops a foot drop after a revision total hip replacement.

Answer 18

20. A 56 year old man undergoes a low anterior resection with legs in the Lloyd-Davies position. Post operatively he complains of foot drop.You answered Sciatic nerveThe correct answer is Peroneal nervePositioning legs in Lloyd- Davies stirrups can carry the risk of peroneal nerve neuropraxia if not done carefully.21. A 23 year old man complains of severe groin pain several weeks after a difficult inguinal hernia repair.Ilioinguinal nerveThe ilioinguinal nerve may have been entrapped in the mesh causing a neuroma.22. A 72 year old man develops a foot drop after a revision total hip replacement.You answered Tibial NerveThe correct answer is Sciatic nerveThis may be done by a number of approaches, in this scenario a posterior approach is the most likely culprit.

Question 19

Question 23 of 328 A 68 year old man falls onto an outstretched hand. Following the accident he is examined in the emergency department. On palpating his anatomical snuffbox there is tenderness noted in the base. What is the most likely injury in this scenario? A. Rupture of the tendon of flexor pollicis B. Scaphoid fracture C. Distal radius fracture D. Rupture of flexor carpi ulnaris tendon E. None of the above

Answer 19

Scaphoid fractureA fall onto an outstretched hand is a common mechanism of injury for a scaphoid fracture. This should be suspected clinically if there is tenderness in the base of the anatomical snuffbox. A tendon rupture would not result in bony tenderness.

Question 20

Question 24 of 328 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? A. Stellate ganglion B. Ciliary ganglion C. Otic ganglion D. Trigeminal nerve E. Greater petrosal nerve

Answer 20

Greater petrosal nerveThe greater petrosal nerve may be injured and carries fibres for lacrimation (see below)

Question 21

Question 25 of 328 Which of the following structures passes through the quadrangular space near the humeral head? A. Axillary artery B. Radial nerve C. Axillary nerve D. Median nerve E. Transverse scapular artery

Answer 21

Axillary nerveThe quadrangular space is bordered by the humerus laterally, subscapularis 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.

Question 22

Question 26 of 328 Which of the following pairings of foramina and their contents is not correct? A. Superior orbital fissure and the oculomotor nerve B. Foramina rotundum and the maxillary nerve C. Jugular foramen and the hypoglossal nerve D. Foramina spinosum and the middle meningeal artery E. Foramina lacerum and the internal carotid artery

Answer 22

Jugular foramen and the hypoglossal nerveThe hypoglossal nerve passes through the hypoglossal canal.

Question 23

Question 27 of 328 A 55 year old man with carcinoma of the larynx is undergoing a difficult laryngectomy. The surgeons divide the thyrocervical trunk, from which of the following vessels does this structure most commonly originate? A. Subclavian artery B. Common carotid artery C. Vertebral artery D. External carotid artery E. Internal carotid artery

Answer 23

Subclavian arteryThe thyrocervical trunk is a branch of the subclavian artery. It arises from the first part between the subclavian artery and the inner border of scalenus anterior. It branches off the subclavian distal to the vertebral artery.

Question 24

Question 28 of 328 The following structures are closely related to the brachiocephalic artery except: A. Trachea posteriorly B. Right brachiocephalic vein C. Inferior thyroid vein D. Right recurrent laryngeal nerve E. None of the above

Answer 24

Right recurrent laryngeal nerveThere is no brachiocephalic artery on the left, however the left brachiocephalic vein lies anteriorly to the roots of all the 3 great arteries (including the brachiocephalic artery). The right recurrent laryngeal nerve has no relation to the brachiocephalic artery.

Question 25

Question 29 of 328 Which of the following structures separates the ulnar artery from the median nerve? A. Brachioradialis B. Pronator teres C. Tendon of biceps brachii D. Flexor carpi ulnaris E. Brachialis

Answer 25

Pronator teresIt lies deep to pronator teres and this separates it from the median nerve

Question 26

Question 30 of 328 Which muscle is supplied by the superficial peroneal nerve? A. Peroneus tertius B. Sartorius C. Adductor magnus D. Peroneus brevis E. Gracilis

Answer 26

Peroneus brevis

Question 27

Question 31 of 328 A 32 year old motorcyclist is involved in a road traffic accident. His humerus is fractured and severely displaced. At the time of surgical repair the surgeon notes that the radial nerve has been injured. Which of the following muscles is least likely to be affected by an injury at this site? A. Extensor carpi radialis brevis B. Brachioradialis C. Abductor pollicis longus D. Extensor pollicis brevis E. None of the above

Answer 27

None of the aboveMuscles supplied by the radial nerveBESTBrachioradialisExtensorsSupinatorTricepsThe radial nerve supplies the extensor muscles, abductor pollicis longus and extensor pollicis brevis (the latter two being innervated by the posterior interosseous branch of the radial nerve).

Question 28

Question 32 of 328 A man develops an infection in his external auditory meatus. The infection is extremely painful. Which of the following nerves conveys sensation from this region? A. Occipital branch of the trigeminal nerve B. Vestibulocochlear nerve C. Facial nerve D. Auriculotemporal nerve E. Maxillary branch of the trigeminal nerve

Answer 28

Auriculotemporal nerveTensor tympania and stapedius are the only two muscles of the middle ear. Contraction of tensor tympani will tend to dampen the vibrations produced by loud sounds, it is innervated by a branch of the trigeminal nerve. The stapedius dampens movements of the ossicles in response to loud sounds and is innervated by a branch of the facial nerve.The auriculotemporal nerve, which is derived from the mandibular branch of the trigeminal nerve supplies this area.

Question 29

Question 33 of 328 Which muscle is responsible for causing flexion of the interphalangeal joint of the thumb? A. Flexor pollicis longus B. Flexor pollicis brevis C. Flexor digitorum superficialis D. Flexor digitorum profundus E. Adductor pollicis

Answer 29

Flexor pollicis longusThere are 8 muscles:1. Two flexors (flexor pollicis brevis and flexor pollicis longus)2. Two extensors (extensor pollicis brevis and longus)3. Two abductors (abductor pollicis brevis and longus)4. One adductor (adductor pollicis)5. One muscle that opposes the thumb by rotating the CMC joint (opponens pollicis).Flexor and extensor longus insert on the distal phalanx moving both the MCP and IP joints.

Question 30

Question 34 of 328 Which of the following structures separates the posterior cruciate ligament from the popliteal artery? A. Oblique popliteal ligament B. Transverse ligament C. Popliteus tendon D. Biceps femoris E. Semitendinosus

Answer 30

Oblique popliteal ligamentThe posterior cruciate ligament is separated from the popliteal vessels at its origin by the oblique popliteal ligament. The transverse ligament is located anteriorly.

Question 31

Question 35 of 328 How many compartments are there in the lower leg? A. 2 B. 1 C. 3 D. 5 E. 4

Answer 31

4The deep 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.

Question 32

Question 36 of 328 Which structure is least likely to be found at the level of the sternal angle? A. Left brachiocephalic vein B. Intervertebral discs T4-T5 C. Start of aortic arch D. 2nd pair of costal cartilages E. Bifurcation of the trachea into left and right bronchi

Answer 32

The left brachiocephalic vein lies posterior to the manubrium, at the level of its upper border. The sternal angle refers to the transition between manubrium and sternum and therefore will not include the left brachiocephalic vein.

Question 33

Question 37 of 328 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? A. Vitellino-intestinal duct B. Hind gut C. Mid gut D. Fore gut E. Woolffian duct

Answer 33

Hind GutThe left colon is embryologically part of the hind gut. Which accounts for its separate blood supply via the IMA.

Question 34

Question 38 of 328 What is the most useful test to clinically distinguish between an upper and lower motor neurone lesion of the facial nerve? A. Blow cheeks out B. Loss of chin reflex C. Close eye D. Raise eyebrow E. Open mouth against resistance

Answer 34

Raise EyebrowUpper motor neurone lesions of the facial nerve- Paralysis of the lower half of face.Lower motor neurone lesion- Paralysis of the entire ipsilateral face.

Question 35

Question 39 of 328 An 18 year old man is stabbed in the axilla during a fight. His axillary artery is lacerated and repaired. However, the surgeon neglects to repair an associated injury to the upper trunk of the brachial plexus. Which of the following muscles is least likely to demonstrate impaired function as a result? A. Palmar interossei B. Infraspinatus C. Brachialis D. Supinator brevis E. None of the above

Answer 35

The palmar interossei are supplied by the ulnar nerve. Which lies inferiorly and is therefore less likely to be injured.

Question 36

Question 40 of 328 A 23 year old man is involved in a fight, during the dispute he sustains a laceration to the posterior aspect of his right arm, approximately 2cm proximal to the olecranon process. On assessment in the emergency department he is unable to extend his elbow joint. Which of the following tendons is most likely to have been cut? A. Triceps B. Pronator teres C. Brachioradialis D. Brachialis E. Biceps

Answer 36

TricepsThe triceps muscle extends the elbow joint. The other muscles listed all produce flexion of the elbow joint.

Question 37

Question 41 of 328 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? A. Adductor longus B. Pectineus C. Adductor magnus D. Sartorius E. Gracilis

Answer 37

Sartorius is supplied by the femoral nerve. In approximately 20% of the population, pectineus is supplied by the accessory obturator nerve.

Question 38

Question 42 of 328 You excitedly embark on your first laparoscopic cholecystectomy and during the operation the anatomy of Calots triangle is more hostile than anticipated. Whilst trying to apply a haemostatic clip you avulse the cystic artery. This is followed by brisk haemorrhage. From which source is this most likely to originate ? A. Right hepatic artery B. Portal vein C. Gastroduodenal artery D. Liver bed E. Common hepatic artery

Answer 38

Right hepatic arteryThe cystic artery is a branch of the right hepatic artery. There are recognised variations in the anatomy of the blood supply to the gallbladder. However, the commonest situation is for the cystic artery to branch from the right hepatic artery.

Question 39

Question 43 of 328 A 43 year old man suffers a pelvic fracture which is complicated by an injury to the junction of the membranous urethra to the bulbar urethra. In which of the following directions is the extravasated urine most likely to pass? A. Posteriorly into extra peritoneal tissues B. Laterally into the buttocks C. Into the abdomen D. Anteriorly into the connective tissues surrounding the scrotum E. None of the above

Answer 39

Anteriorly into the connective tissues surrounding the scrotumThe superficial perineal pouch is a compartment bounded superficially by the superficial perineal fascia, deep by the perineal membrane (inferior fascia of the urogenital diaphragm), and laterally by the ischiopubic ramus. It contains the crura of the penis or clitoris, muscles, viscera, blood vessels, nerves, the proximal part of the spongy urethra in males, and the greater vestibular glands in females.When urethral rupture occurs as in this case the urine will tend to pass anteriorly because the fascial condensations will prevent lateral and posterior passage of the urine.

Question 40

Question 44 of 328 Which of the following does not pass through the superior orbital fissure? A. Oculomotor nerve B. Abducens nerve C. Ophthalmic artery D. Ophthalmic division of the trigeminal nerve E. Ophthalmic veins

Answer 40

The ophthalmic artery, a branch of the internal carotid enters the orbit with the optic nerve in the canal.

Question 41

Question 45 of 328 Which of the following muscles does not attach to the radius? A. Pronator quadratus B. Biceps C. Brachioradialis D. Supinator E. Brachialis

Answer 41

The brachialis muscle inserts into the ulna. The other muscles are all inserted onto the radius.

Question 42

Question 46 of 328 Which nerve supplies the 1st web space of the foot? A. Popliteal nerve B. Superficial peroneal nerve C. Deep peroneal nerve D. Tibial nerve E. Saphenous nerve

Answer 42

Deep peroneal nerve

Question 43

Question 47 of 328 During the course of a radical gastrectomy the surgeons detach the omentum and ligate the right gastro-epiploic artery. From which vessel does it originate? A. Superior mesenteric artery B. Inferior mesenteric artery C. Coeliac axis D. Common hepatic artery E. Gastroduodenal artery

Answer 43

Gastroduodenal arteryThe gastroduodenal artery arises at the superior part of the duodenum and descends behind it to terminate at its lower border. It terminates by dividing into the right gastro-epiploic artery and the superior pancreaticoduodenal artery. The right gastro-opiploic artery passes to the left and passes between the layers of the greater omentum to anastomose with the left gastro-epiploic artery.

Question 44

Question 48 of 328 Which of the following is not an intrinsic muscle of the hand? A. Opponens pollicis B. Palmaris longus C. Flexor pollicis brevis D. Flexor digiti minimi brevis E. Opponens digiti minimi

Answer 44

Palmaris LongusMnemonic for intrinsic hand muscles’A OF A OF A’A bductor pollicis brevisO pponens pollicisF lexor pollicis brevisA dductor pollicis (thenar muscles)O pponens digiti minimiF lexor digiti minimi brevisA bductor digiti minimi (hypothenar muscles)Palmaris longus originates in the forearm.

Question 45

Question 49 of 328 A man with lung cancer and bone metastasis in the thoracic spinal vertebral bodies, sustains a pathological fracture at the level of T4. The fracture is unstable and the spinal cord is severely compressed at this level. Which of the findings below will not be present? A. Extensor plantar reflexes B. Spasticity of the lower limbs C. Diminished patellar tendon reflex D. Urinary incontinence E. Sensory ataxia

Answer 45

Diminished patellar tendon reflexA thoracic cord lesion causes spastic paraperesis, hyperrflexia and extensor plantar responses (UMN lesion), incontinence, sensory loss below the lesion and ‘sensory’ ataxia.

Question 46

Question 50 of 328 Through which of the following foramina does the genital branch of the genitofemoral nerve exit the abdominal cavity? A. Superficial inguinal ring B. Sciatic notch C. Obturator foramen D. Femoral canal E. Deep inguinal ring

Answer 46

Deep inguinal ringThe genitofemoral nerve divides into two branches as it approaches the inguinal ligament. The genital branch passes anterior to the external iliac artery through the deep inguinal ring into the inguinal canal. It communicates with the ilioinguinal nerve in the inguinal canal (though this is seldom of clinical significance).

Question 47

Question 51 of 328 A 28 year old man lacerates the posterolateral aspect of his wrist with a knife in an attempted suicide. On arrival in the emergency department the wound is inspected and found to be located over the lateral aspect of the extensor retinaculum (which is intact). Which of the following structures is at greatest risk of injury? A. Superficial branch of the radial nerve B. Radial artery C. Dorsal branch of the ulnar nerve D. Tendon of extensor carpi radialis brevis E. Tendon of extensor digiti minimi

Answer 47

Superficial branch of the radial nerveThe superficial branch of the radial nerve passes superior to the extensor retinaculum in the position of this laceration and is at greatest risk of injury. The dorsal branch of the ulnar nerve and artery also pass superior to the extensor retinaculum n but are located medially

Question 48

Question 52 of 328 A 43 year old man is reviewed in the clinic following a cardiac operation. A chest x-ray is performed and a circular radio-opaque structure is noted medial to the 4th interspace on the left. Which of the following procedures is the patient most likely to have undergone? A. Aortic valve replacement with metallic valve B. Tricuspid valve replacement with metallic valve C. Tricuspid valve replacement with porcine valve D. Pulmonary valve replacement with porcine valve E. Mitral valve replacement with metallic valve

Answer 48

Mitral valve replacement with metallic valve

Question 49

Question 53 of 328 A 63 year old lady is diagnosed as having an endometrial carcinoma arising from the uterine body. To which nodal region will the tumour initially metastasise? A. Para aortic nodes B. Iliac lymph nodes C. Inguinal nodes D. Pre sacral nodes E. Mesorectal lymph nodes

Answer 49

Iliac lymph nodesTumours of the uterine body will tend to spread to the iliac nodes initially. Tumour expansion crossing different nodal margins this is of considerable clinical significance, if nodal clearance is performed during a Wertheims type hysterectomy

Question 50

Question 54 of 328 Transection of the radial nerve at the level of the axilla will result in all of the following except: A. Loss of elbow extension. B. Loss of extension of the interphalangeal joints. C. Loss of metacarpophalangeal extension. D. Loss of triceps reflex. E. Loss of sensation overlying the first dorsal interosseous.

Answer 50

Loss of extension of the interphalangeal jointsThese may still extend by virtue of retained lumbrical muscle function

Question 51

Question 55 of 328 Which of the following structures is not located in the superficial perineal space in females? A. Posterior labial arteries B. Pudendal nerve C. Superficial transverse perineal muscle D. Greater vestibular glands E. None of the above

Answer 51

The pudendal nerve is located in the deep perineal space and then branches to innervate more superficial structures.

Question 52

Question 56 of 328 Which of the following is not a branch of the hepatic artery? A. Pancreatic artery B. Cystic artery C. Right gastric artery D. Right hepatic artery E. Right Gastroepiploic artery

Answer 52

The pancreatic artery is a branch of the splenic artery.

Question 53

Question 57 of 328 Which of the following structures does not pass behind the piriformis muscle in the greater sciatic foramen? A. Sciatic nerve B. Posterior cutaneous nerve of the thigh C. Inferior gluteal artery D. Obturator nerve E. None of the above

Answer 53

The obturator nerve does not pass through the greater sciatic foramen.

Question 54

Question 58 of 328 A 56 year old man is undergoing a nephrectomy. The surgeons divide the renal artery. At what level do these usually branch off the abdominal aorta? A. T9 B. L2 C. L3 D. T10 E. L4

Answer 54

The renal arteries usually branch off the aorta on a level with L2.

Question 55

Question 59 of 328 A 23 year old man is shot in the chest during a robbery. The left lung is lacerated and is bleeding. An emergency thoracotomy is performed. The surgeons place a clamp over the hilum of the left lung. Which of the following structures lies most anteriorly at this level? A. Vagus nerve B. Oesophagus C. Descending aorta D. Phrenic nerve E. Azygos vein

Answer 55

The phrenic nerve lies anteriorly at this point. The vagus passes anteriorly and then arches backwards immediately superior to the root of the left bronchus, giving off the recurrent laryngeal nerve as it does so.

Question 56

Question 60 of 328 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? A. Ileocolic artery B. Mesentery of the caecum C. Gonadal vessels D. Lateral peritoneal attachments of the caecum E. Right colic artery

Answer 56

Lateral peritoneal attachments of the caecumThe 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.

Question 57

Question 61 of 328 Which of the following muscles does not adduct the shoulder? A. Teres major B. Pectoralis major C. Coracobrachialis D. Supraspinatus E. Latissimus dorsi

Answer 57

Supraspinatus is an abductor of the shoulder

Question 58

Question 62 of 328 Which of these muscles is innervated by the cervical branch of the facial nerve? A. Masseter B. Sternocleidomastoid C. Platysma D. Geniohyoid E. Sternothyroid

Answer 58

The cervical branch of the facial nerve innervates platysma

Question 59

Question 63 of 328 During a thyroidectomy the surgeons ligate the inferior thyroid artery. From which vessel does this structure usually originate? A. External carotid artery B. Thyrocervical trunk C. Internal carotid artery D. Subclavian artery E. Vertebral artery

Answer 59

Thyrocervical trunkThe inferior thyroid artery originates from the thyrocervical trunk. This is a branch of the subclavian artery.

Question 60

Question 64 of 328 A 56 year old man is left impotent following an abdomino-perineal excision of the colon and rectum. What is the most likely explanation? A. Psychosexual issues related to an end colostomy B. Damage to the sacral venous plexus during total mesorectal excision C. Damage to the left ureter during sigmoid mobilisation D. Damage to the hypogastric plexus during mobilisation of the inferior mesenteric artery E. Damage to the internal iliac artery during total mesorectal excision

Answer 60

Damage to the hypogastric plexus during mobilisation of the inferior mesenteric arteryAutonomic nerve injury is the most common cause

Question 61

Question 65 of 328 A 73 year old man is due to undergo a radical prostatectomy for carcinoma of the prostate gland. To which of the following lymph nodes will the tumour drain primarily? A. Para aortic B. Internal iliac C. Superficial inguinal D. Meso rectal E. None of the above

Answer 61

The prostate lymphatic drainage is primarily to the internal iliac nodes and also the sacral nodes. Although internal iliac is the first site.

Question 62

Question 66 of 328 Which of the following statements relating to the vertebral column is false? A. There are 7 cervical vertebrae B. The cervical and lumbar lordosis are secondary curves developing after birth due to change in shape of the intervertebral discs C. The lumbar vertebrae do not have a transverse process foramina D. The lumbar vertebrae receive blood directly from the aorta E. The spinous process is formed by the junction of the pedicles posteriorly

Answer 62

The spinous process is formed by 2 laminae posteriorly.

Question 63

Question 67 of 328 A 78 year old lady falls over in her nursing home and sustains a displaced intracapsular fracture of the femoral neck. A decision is made to perform a hemi arthroplasty through a lateral approach. Which of these vessels will be divided to facilitate access? A. Saphenous vein B. Superior gluteal artery C. Superficial circumflex iliac artery D. Profunda femoris artery E. Transverse branch of the lateral circumflex artery

Answer 63

ransverse branch of the lateral circumflex arteryDuring the Hardinge style lateral approach the transverse branch of the lateral circumflex artery is divided to gain access. The vessels and its branches are illustrated below:

Question 64

Question 68 of 328 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? A. Superior thyroid artery B. Internal carotid artery C. Direct branches from the thoracic aorta D. Inferior thyroid artery E. Subclavian artery

Answer 64

Inferior thyroid arteryThe 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.

Question 65

Question 69 of 328 Which of the following structures is not closely related to the brachial artery? A. Ulnar nerve B. Median nerve C. Cephalic vein D. Long head of triceps E. Median cubital vein

Answer 65

The cephalic vein lies superficially and on the contralateral side of the arm to the brachial artery. The relation of the ulnar nerves and others are demonstrated in the image below:

Question 66

Question 70 of 328 The following statements relating to the musculocutaneous nerve are true except? A. It arises from the lateral cord of the brachial plexus B. It provides cutaneous innervation to the lateral side of the forearm C. If damaged then extension of the elbow joint will be impaired D. It supplies the biceps muscle E. It runs beneath biceps

Answer 66

If damaged then extension of the elbow joint will be impairedIt supplies biceps, brachialis and coracobrachialis so if damaged then elbow flexion will be impaired.

Question 67

Question 71 of 328 Which ligament keeps the head of the radius connected to the radial notch of the ulna? A. Annular (orbicular) ligament B. Quadrate ligament C. Radial collateral ligament of the elbow D. Ulnar collateral ligament E. Radial collateral ligament

Answer 67

The annular ligament connects the radial head to the radial notch of the ulna. This is illustrated below:

Question 68

Question 72 of 328 A 38 year old man presents to the clinic with shoulder weakness. On examination he has an inability to initiate shoulder abduction. Which of the nerves listed below is least likely to be functioning normally? A. Suprascapular nerve B. Medial pectoral nerve C. Axillary nerve D. Median nerve E. Radial nerve

Answer 68

Suprascapular nerve

Question 69

Question 73 of 328 Which of the following statements relating to the Cavernous Sinus is false? A. The pituitary gland lies medially B. The internal carotid artery passes through it C. The temporal lobe of the brain is a lateral relation D. The mandibular branch of the trigeminal and optic nerve lie on the lateral wall E. The ophthalmic veins drain into the anterior aspect of the sinus

Answer 69

The mandibular branch of the trigeminal and optic nerve lie on the lateral wallThe veins that drain into the sinus are important as sepsis can cause cavernous sinus thrombosis. The maxillary branch of the trigeminal and not the mandibular branches pass through the sinus

Question 70

Question 74 of 328 Which of the following is not a branch of the subclavian artery? A. Superior thyroid artery B. Vertebral artery C. Thyrocervical trunk D. Internal thoracic artery E. Dorsal scapular artery

Answer 70

Superior thyroid arteryMnemonic for the branches of the subclavian artery: VIT C & DV ertebral arteryI nternal thoracicT hyrocervical trunkC ostalcervical trunkD orsal scapularSuperior thyroid artery is a branch of the external carotid artery.

Question 71

Question 75 of 328 During the repair of an atrial septal defect the surgeons note that blood starts to leak from the coronary sinus. Which structure forms the largest tributary of the coronary sinus? A. Thesbian veins B. Great cardiac vein C. Oblique vein D. Small cardiac veins E. None of the above

Answer 71

The great cardiac vein runs in the anterior interventricular groove, and is the largest tributary of the coronary sinus. The Thesbian veins drain into the heart directly.

Question 72

Question 76 of 328 Which of the following vessels provides the greatest contribution to the arterial supply of the breast? A. External mammary artery B. Thoracoacromial artery C. Internal mammary artery D. Lateral thoracic artery E. Subclavian artery

Answer 72

Internal mammary artery60% of the arterial supply to the breast is derived from the internal mammary artery. The external mammary and lateral thoracic arteries also make a significant (but lesser) contribution. This is of importance clinically in performing reduction mammoplasty procedures.

Question 73

Question 77 of 328 Which of the following muscles is supplied by the external laryngeal nerve? A. Transverse arytenoid B. Cricothyroid C. Thyro-arytenoid D. Posterior crico-arytenoid E. Oblique arytenoid

Answer 73

CricothyroidThe others are all supplied by the recurrent laryngeal nerve.

Question 74

Question 78 of 328 A 28 year old man has sustained a non salvageable testicular injury to his left testicle. The surgeon decides to perform an orchidectomy and divides the left testicular artery. From which of the following does this vessel originate? A. Abdominal aorta B. Internal iliac artery C. Inferior epigastric artery D. Inferior vesical artery E. External iliac artery

Answer 74

Abdominal AortaThe testicular artery is a branch of the abdominal aorta.

Question 75

Question 79 of 328 During a carotid endarterectomy the internal carotid artery is cross clamped. Assuming that no shunt is inserted, which of the following vessels will not have diminished or absent flow as a result? A. Anterior cerebral artery B. Ophthalmic artery C. Middle cerebral artery D. Maxillary artery E. None of the above

Answer 75

Maxillary ArteryMnemonic for branches of the cerebral portion of the internal carotid artery ‘Only Press Carotid Arteries Momentarily’Only = OpthalmicPress = Posterior communicatingCarotid = ChoroidalArteries = Anterior cerebralMomentarily = Middle cerebralThe maxillary artery is a branch of the external carotid artery.

Question 76

Question 80 of 328 A 72 year old lady with osteoporosis falls and sustains an intracapsular femoral neck fracture. The fracture is completely displaced. Which of the following vessels is the main contributor to the arterial supply of the femoral head? A. Deep external pudendal artery B. Superficial femoral artery C. External iliac artery D. Circumflex femoral arteries E. Superficial external pudendal artery

Answer 76

Circumflex femoral arteriesThe vessels which form the anastomoses around the femoral head are derived from the medial and lateral circumflex femoral arteries. These are usually derived from the profunda femoris artery

Question 77

Question 81 of 328 A 21 year old man is hit with a hammer and sustains a depressed skull fracture at the vertex. Which of the following sinuses is at risk in this injury? A. Superior sagittal sinus B. Inferior petrosal sinus C. Transverse sinus D. Inferior sagittal sinus E. Straight sinus

Answer 77

The superior sagittal sinus is at greatest risk in this pattern of injury. This sinus begins at the front of the crista galli and courses backwards along the falx cerebri. It becomes continuous with the right transverse sinus near the internal occipital protuberance.

Question 78

Question 82 of 328 A 44 year old man is stabbed in the back and the left kidney is injured. A haematoma forms, which of the following fascial structures will contain the haematoma? A. Waldeyers fascia B. Sibsons fascia C. Bucks fascia D. Gerotas fascia E. Denonvilliers fascia

Answer 78

Gerotas FasciaWaldeyers fascia- Posterior ano-rectumSibsons fascia- Lung apexBucks fascia- Base of penisGerotas fascia- Surrounding kidneyDenonvilliers fascia- Between rectum and prostate

Question 79

Question 83 of 328 A baby is found to have a Klumpke’s palsy post delivery. Which of the following is most likely to be present? A. Loss of flexors of the wrist B. Weak elbow flexion C. Pronation of the forearm D. Adducted shoulder E. Shoulder medially rotated

Answer 79

Loss of flexors of the wristFeatures of Klumpkes Paralysis Claw hand (MCP joints extended and IP joints flexed) Loss of sensation over medial aspect of forearm and hand Horner’s syndrome Loss of flexors of the wristA C8, T1 root lesion is called Klumpke’s paralysis and is caused by delivery with the arm extended.

Question 80

Question 84 of 328 A 22 year old man undergoes a superficial parotidectomy for a pleomorphic adenoma. The operation does not proceed well and a diathermy malfunction results in division of the buccal branch of the facial nerve. Which of the following muscles will not demonstrate impaired function as a result? A. Zygomaticus minor B. Mentalis C. Buccinator D. Levator anguli oris E. Risorius

Answer 80

MentalisBuccal branch suppliesZygomaticus minor Elevates upper lipRisorius Aids smileBuccinator Pulls corner of mouth backward and compresses cheekLevator anguli oris Pulls angles of mouth upward and toward midlineOrbicularis Closes and tightens lips togetherNasalis Flares nostrils and compresses nostrils

Question 81

Question 85 of 328 At which of the following vertebral body levels does the common carotid artery typically bifurcate into the external and internal carotid arteries? A. C4 B. C2 C. C1 D. C6 E. C7

Answer 81

C4It terminates at the upper border of the thyroid cartilege, Which is usually located at C4

Question 82

Question 86 of 328 A man is stabbed in the chest to the right of the manubriosternal angle. Which structure is least likely to be injured in this case? A. Aortic arch B. The trachea C. Right phrenic nerve D. Right recurrent laryngeal nerve E. Brachiocephalic vein

Answer 82

The right recurrent laryngeal nerve branches off the right vagus more proximally and arches posteriorly round the subclavian artery. So of the structures given it is the least likely to be injured

Question 83

Question 87 of 328 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? A. Apparent enopthalmos B. Loss of sweating on the entire ipsilateral side of the face C. Constricted pupil D. Mild ptosis E. Normal sympathetic activity in the torso

Answer 83

Loss of sweating on the entire ipsilateral side of the faceThe 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.

Question 84

Question 88 of 328 Which of the following types of epithelium lines the lumenal surface of the normal oesophagus? A. Non keratinised stratified squamous epithelium B. Ciliated columnar epithelium C. Keratinised stratified squamous epithelium D. Non ciliated columnar epithelium E. None of the above

Answer 84

Non keratinised stratified squamous epitheliumThe oesphagus is lined by non keratinised stratified squamous epithelium. Changes to glandular type epithelium occur as part of metaplastic processes in reflux.

Question 85

Question 89 of 328 A 23 year old man is stabbed in the neck, in the region between the omohyoid and digastric muscles, the injury is explored surgically. At operation a nerve injury is identified immediately superior to the lingual artery as is branches off the external carotid artery. Which of the following is the most likely result of this injury? A. Paralysis of the ipsilateral side of the tongue B. Abduction of the ipsilateral vocal cord C. Winging of the scapula D. Paralysis of the ipsilateral hemi diaphragm E. Inability to abduct the shoulder

Answer 85

Paralysis of the ipsilateral side of the tongueThe hypoglossal nerve runs anterior to the external carotid, above the lingual arterial branch. If damaged then ipsilateral paralysis of the genioglossus, hyoglossus and styloglossus muscles will occur. If the patient is asked to protrude their tongue then it will tend to point to the affected side.

Question 86

Question 90 of 328 Which of the following structures is not directly related to the right adrenal gland? A. Diaphragm posteriorly B. Bare area of the liver anteriorly C. Right renal vein D. Inferior vena cava E. Hepato-renal pouch

Answer 86

The right renal vein is very short and lies more inferiorly.

Question 87

Question 91 of 328 With respect to the basilic vein, which statement is false? A. Its deep anatomical location makes it unsuitable for use as an arteriovenous access site in fistula surgery B. It originates from the dorsal venous network on the hand C. It travels up the medial aspect of the forearm D. Halfway between the shoulder and the elbow it lies deep to muscle E. It joins the brachial vein to form the axillary vein

Answer 87

Its deep anatomical location makes it unsuitable for use as an arteriovenous access site in fistula surgeryIt is used in arteriovenous fistula surgery during a procedure known as a basilic vein transposition.

Question 88

Question 92 of 328 Mobilisation of the left lobe of the liver will facilitate surgical access to which of the following? A. Abdominal oesophagus B. Duodenum C. Right colic flexure D. Right kidney E. Pylorus of stomach

Answer 88

Abdominal oesophagusThe fundus of the stomach is a posterior relation. The pylorus lies more inferolaterally. During a total gastrectomy division of the ligaments holding the left lobe of the liver will facilitate access to the proximal stomach and abdominal oesophagus. This manoeuvre is seldom beneficial during a distal gastrectomy.

Question 89

Question 93 of 328 The following statements relating to the ankle joint are true except? A. Three groups of ligaments provide mechanical stability B. The sural nerve lies medial to the Achilles tendon at its point of insertion C. Eversion of the foot occurs at the sub talar joint D. The flexor hallucis longus tendon is the most posterior structure at the medial malleolus E. The saphenous nerve crosses the ankle joint.

Answer 89

The sural nerve lies medial to the Achilles tendon at its point of insertionThe 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 tibia vein, posterior tibial artery, nerve, flexor hallucis longus.

Question 90

Question 94 of 328 A 78 year old man is lifting a heavy object when a feels a pain in his forearm and is unable to continue. He has a swelling over his upper forearm. An MRI scan shows a small cuff of tendon still attached to the radial tuberosity consistent with a recent tear. Which of the following muscles has been injured? A. Pronator teres B. Supinator C. Aconeus D. Brachioradialis E. Biceps brachii

Answer 90

Biceps brachiiBiceps inserts into the radial tuberosity. Distal injuries of this muscle are rare but are reported and are clinically more important than more proximal ruptures.

Question 91

Question 95 of 328 The oesophagus is constricted at the following levels apart from: A. Cricoid cartilage B. Arch of the aorta C. Lower oesophageal sphincter D. Left main stem bronchus E. Diaphragmatic hiatus

Answer 91

Lower oesophageal sphincterThe oesophagus is not constricted at the level of the lower oesophageal sphincter.

Question 92

Question 96 of 328 A 19 year old man is playing rugby when he suddenly notices a severe pain at the posterolateral aspect of his right thigh. Which of the following muscle groups is most likely to have been injured? A. Semimembranosus B. Semitendinosus C. Long head of biceps femoris D. Gastrocnemius E. Soleus

Answer 92

Long head of biceps femorisThe biceps femoris is the laterally located hamstring muscle. The semitendinosus and semimembranosus are located medially. Rupture of gastrocnemius and soleus may occur but is less common.

Question 93

Question 97 of 328 Which of the following is a branch of the third part of the axillary artery? A. Superior thoracic B. Lateral thoracic C. Dorsal scapular D. Thoracoacromial E. Posterior circumflex humeral

Answer 93

Posterior circumflex humeralThe other branches include: Subscapular Anterior circumflex humeral

Question 94

Question 98 of 328 Which of the following structures separates the intervertebral disks from the spinal cord? A. Anterior longitudinal ligament B. Posterior longitudinal ligament C. Supraspinous ligament D. Interspinous ligament E. Ligamentum flavum

Answer 94

The posterior longitudinal ligament overlies the posterior aspect of the vertebral bodies. It also overlies the posterior aspect of the intervertebral disks.

Question 95

Question 99 of 328 At what level does the aorta bifurcate into the left and right common iliac arteries? A. L1 B. L2 C. L3 D. L4 E. L5

Answer 95

L4The aorta typically bifurcates at L4. This level is usually fairly constant and is often tested in the exam.

Question 96

Question 100 of 328 A 23 year old man is due to undergo a mitral valve repair for mitral regurgitation. Which of the following is a feature of the mitral valve? A. Its closure is marked by the first heart sound B. It has two anterior cusps C. The chordae tendinae attach to the anterior cusps only D. The chordae tendinae anchor the valve directly to the wall of the left ventricle E. It is best auscultated in the left third interspace

Answer 96

Its closure is marked by the first heart soundThe mitral valve is best auscultated over the cardiac apex, where its closure marks the first heart sound. It has only two cusps. These are attached to chordae tendinae which themselves are linked to the wall of the ventricle by the papillary muscles.

Question 97

Question 101-103 of 328 Theme: Nerve lesionsA. IntercostobrachialB. MedianC. AxillaryD. RadialE. UlnarF. MusculocutaneousG. Brachial plexus upper cordH. Brachial plexus lower cordPlease select the most likely nerve injury for the scenarios given. Each option may be used once, more than once or not at all.101. A 23 year old rugby player sustains a Smiths Fracture. On examination opposition of the thumb is markedly weakened.102. A 45 year old lady recovering from a mastectomy and axillary node clearance notices that sensation in her armpit is impaired.103. 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.

Answer 97

Question 101-103 of 328 Theme: Nerve lesionsA. IntercostobrachialB. MedianC. AxillaryD. RadialE. UlnarF. MusculocutaneousG. Brachial plexus upper cordH. Brachial plexus lower cordPlease select the most likely nerve injury for the scenarios given. Each option may be used once, more than once or not at all.101. A 23 year old rugby player sustains a Smiths Fracture. On examination opposition of the thumb is markedly weakened.You answered RadialThe correct answer is MedianThis high velocity injury can often produce significant angulation and displacement. Both of these may impair the function of the median nerve with loss of function of the muscles of the thenar eminence102. A 45 year old lady recovering from a mastectomy and axillary node clearance notices that sensation in her armpit is impaired.You answered RadialThe correct answer is IntercostobrachialThe intercostobrachial nerves are frequently injured during axillary dissection. These nerves traverse the axilla and supply cutaneous sensation.103. 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.You answered UlnarThe correct answer is MedianThis is a common injury in children. In this case the angulation and displacement have resulted in median nerve injury.

Question 98

Question 104 of 328 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? A. Lingual nerve B. Buccal nerve C. Facial nerve D. Glossopharyngeal E. Vagus

Answer 98

The lingual nerve wraps around Whartons duct. The lingual nerve provides sensory supply to the anterior 2/3 of the tongue.

Question 99

Question 105 of 328 Which of the following is true in connection with the phrenic nerves? A. They both lie anterior to the hilum of the lungs B. They are derived from spinal roots C 2,3,4 C. They pierce the diaphragm at the level of T7 D. They consist of motor fibres only E. None of the above

Answer 99

They both lie anterior to the hilum of the lungsC3,4,5Keeps the diaphragm alive!They both lie anterior to the hilum of the lung. The phrenic nerves have both motor and sensory functions. For this reason sub diaphragmatic pathology may cause referred pain to the shoulder.

Question 100

Question 106 of 328 A 32 year old man presents with an inguinal hernia and undergoes an open surgical repair. The surgeons decide to place a mesh on the posterior wall of the inguinal canal to complete the repair, which of the following structures will lie posterior to the mesh? A. Transversalis fascia B. External oblique C. Rectus abdominis D. Obturator nerve E. None of the above

Answer 100

Transversalis fasciaInguinal canal walls: ‘MALT: 2M, 2A, 2L, 2T’:Starting from superior, moving around in order to posterior:Superior wall (roof): 2 Muscles:Internal oblique, transversus abdominisAnterior wall: 2 Aponeuroses: Aponeurosis of external oblique, Aponeurosis of internal obliqueLower wall (floor): 2 Ligaments: Inguinal Ligament, Lacunar Ligament Posterior wall: 2Ts: Transversalis fascia, Conjoint TendonThis is actually quite a straightforward question. It is simply asking for the structure that forms the posterior wall of the inguinal canal. This is composed of the transversalis fascia, the conjoint tendon and more laterally the deep inguinal ring.

Question 101

Question 107 of 328 A 22 year old man is involved in a fight and is stabbed in the posterior aspect of his right leg. The knife passes into the popliteal fossa. He sustains an injury to his tibial nerve. Which muscle is least likely to be compromised as a result? A. Tibialis posterior B. Flexor hallucis longus C. Flexor digitorum brevis D. Soleus E. Peroneus tertius

Answer 101

Peroneus tertiusPeroneus tertius is innervated by the deep peroneal nerve

Question 102

Question 108 of 328 Which of the following overlies the outer muscular layer of the intrathoracic oesophagus? A. Serosa B. Meissners plexus C. Auerbach’s plexus D. Loose connective tissue E. None of the above

Answer 102

Loose connective tissueThe oesophagus has no serosal covering and hence holds sutures poorly. The Auerbach’s and Meissner’s nerve plexuses lie in between the longitudinal and circular muscle layers and submucosally. The sub mucosal location of the Meissner’s nerve plexus facilitates its sensory role.

Question 103

Question 109 of 328 Which nerve lies medially on the thyroid gland, in the groove between the oesophagus and trachea? A. Vagus nerve B. External laryngeal nerve C. Recurrent laryngeal nerve D. Ansa cervicalis E. Phrenic nerve

Answer 103

Recurrent laryngeal nerveThe recurrent laryngeal nerve may be injured at this site during ligation of the inferior thyroid artery.

Question 104

Question 110 of 328 At which of the following spinal levels does the oesophagus pass through the diaphragm into the abdominal cavity? A. L2 B. L1 C. T10 D. T5 E. T12

Answer 104

T10The oesophagus passes into the abdomen at T10

Question 105

Question 111 of 328 Which of the following nerve roots contribute nerve fibres to the ansa cervicalis? A. C1 only B. C1, C2 and C3 C. C2, C3 and C6 D. C2, C4 and C5 E. C4, C5 and C6

Answer 105

C1, C2 and C3Ansa cervicalis muscles:GHost THought SOmeone Stupid Shot IreneGenioHyoidThyroidHyoidSuperior OmohyoidSternoThyroidSternoHyoidInferior OmohyoidThe ansa cervicalis is composed of a superior and inferior root, derived from C1, C2 and C3. The superior root arises where the nerve crosses the internal carotid artery. It descends anterior to the carotid sheath in the anterior triangle. It is joined in the region of the mid neck by the inferior root. The inferior root may pass either superficially or deep to the internal jugular vein.

Question 106

Question 112 of 328 At which of the following anatomical locations does the common peroneal nerve bifurcate into the superficial and deep peroneal nerves? A. Immediately anterior to the linea aspera B. At the lateral aspect of the neck of the fibula C. Within the substance of tibialis anterior muscle D. At the inferomedial aspect of the popliteal fossa E. Under the medial head of gastrocnemius

Answer 106

At the lateral aspect of the neck of the fibulaThe common peroneal nerve bifurcates at the neck of the fibula (where it is most likely to be injured).

Question 107

Question 113 of 328 A 48 year old motor cyclist sustains a complex lower limb fracture in a motor accident. For a time the popliteal artery is occluded and eventually repaired. Subsequently he develops a compartment syndrome and the anterior and superficial posterior compartments of the lower leg are decompressed. Unfortunately, the operating surgeon neglects to decompress the deep posterior compartment. Which of the following muscles is least likely to be affected as a result? A. Flexor digitorum longus B. Plantaris C. Tibialis posterior D. Flexor hallucis longus E. None of the above

Answer 107

PlantarisMuscles of the deep posterior compartment: Tibialis posterior Flexor hallucis longus Flexor digitorum longus PopliteusThe plantaris muscle lies within the superficial posterior compartment of the lower leg.

Question 108

Question 114 of 328 A 23 year old lady is undergoing a trendelenberg procedure for varicose veins. During the dissection of the saphenofemoral junction, which of the structures listed below is most liable to injury? A. Superficial circumflex iliac artery B. Superficial circumflex iliac vein C. Femoral artery D. Femoral nerve E. Deep external pudendal artery

Answer 108

Deep external pudendal arteryTheme from September 2011 examThe deep external pudendal artery runs under the long saphenous vein close to its origin and may be injured. It is at greatest risk of injury during the flush ligation of the saphenofemoral junction. Provided an injury is identified and vessel ligated, injury is seldom associated with any serious adverse sequelae.

Question 109

Question 115 of 328 Considering the pituitary gland, which of the following is false? A. The anterior pituitary secretes thyroid stimulating hormone B. The anterior pituitary develops from Rathkes pouch C. Patients with craniopharyngioma may develop bi temporal hemianopia D. The pituitary is in direct contact with the optic chiasm E. The posterior pituitary secretes oxytocin via a positive feedback loop

Answer 109

The pituitary is in direct contact with the optic chiasmAlthough the optic chiasm is closely related to the pituitary, and craniopharyngiomas may compress this structure leading to bitemporal hemianopia, it is separated from the chiasm itself by a dural fold.

Question 110

Question 116 of 328 A 24 year old man is involved in a fight and his face is cut with a knife. The wound lies immediately anterior to the tragus of the ear and extends anteriorly. The wound is surgically explored and the laceration is found to be mainly superficial. It is extends slightly more deeply immediately inferior to the main trunk of the facial nerve. Bleeding is observed, from which of the following is it most likely to originate? A. External carotid artery B. Retromandibular vein C. Occipital artery D. Maxillary artery E. Ascending pharyngeal artery

Answer 110

The retromandibular vein lies slightly more deeply than the facial nerve in the parotid gland. It is formed from the maxillary and superficial temporal vein.

Question 111

Question 117 of 328 A 52 year female post hysterectomy attends clinic. She reports pain and reduced sensation over the medial aspect of her thigh. Clinically thigh adduction is weak. What is the most likely nerve injury? A. Obturator nerve B. Sciatic nerve C. Femoral nerve D. L3 cord compression E. Deep peroneal nerve

Answer 111

Obturator nerveThe obturator nerve supplies sensation to the medial aspect of the thigh and causes adduction and internal rotation of the thigh.Injury occurs during pelvic or abdominal surgery.L3 cord compression is unlikely.

Question 112

Question 118 of 328 An ENT surgeon is performing a radical neck dissection. She wishes to fully expose the external carotid artery. To do so she inserts a self retaining retractor close to its origin. Which of the following structures lies posterolaterally to the external carotid at this point? A. Superior thyroid artery B. Internal carotid artery C. Lingual artery D. Facial artery E. None of the above

Answer 112

The internal carotid artery lies posterolaterally to the external carotid artery at their origin from the common carotid. The superior thyroid, lingual and facial arteries all arise from its anterior surface.

Question 113

Question 119 of 328 In Froment’s test which muscle function is tested? A. Flexor pollicis longus B. Adductor pollicis longus C. Abductor pollicis brevis D. Adductor pollicis E. Opponens pollicis

Answer 113

Adductor pollicis

Question 114

Question 120 of 328 A 22 year old man is involved in a fight outside a nightclub. He is stabbed in the back, on the left side, approximately 3cm below the 12th rib in the mid scapular line. The structure most likely to be injured first as a result is the: A. Spleen B. Left kidney C. Left adrenal gland D. Left ureter E. None of the above

Answer 114

The left kidney lies in this location and is the most likely structure to be injured. The Spleen lies more superiorly, and the left adrenal and ureter are unlikely to be injured in isolation.

Question 115

Question 121-123 of 328 Theme: Cutaneous innervationA. Ulnar nerveB. Fifth cervical spinal segmentC. Radial nerveD. Musculocutaneous nerveE. Median nerveF. None of thesePlease select the source of innervation for the region described. Each option may be used once, more than once or not at all.121. The skin on the palmar aspect of the thumb122. The nail bed of the index finger123. The skin overlying the medial aspect of the palm

Answer 115

Question 121-123 of 328 Theme: Cutaneous innervationA. Ulnar nerveB. Fifth cervical spinal segmentC. Radial nerveD. Musculocutaneous nerveE. Median nerveF. None of thesePlease select the source of innervation for the region described. Each option may be used once, more than once or not at all.121. The skin on the palmar aspect of the thumbYou answered Radial nerveThe correct answer is Median nerveThe median nerve supplies cutaneous sensation to this region.See diagram below122. The nail bed of the index fingerYou answered Musculocutaneous nerveThe correct answer is Median nerve123. The skin overlying the medial aspect of the palmYou answered Fifth cervical spinal segmentThe correct answer is Ulnar nerveThis area is innervated by the ulnar nerve.

Question 116

Question 124 of 328 With regard to the sciatic nerve which statement is false? A. It is derived from L4 to S3 B. It contains nerve roots from the posterior division of the lumbosacral plexus only C. It divides to give the tibial nerve and common peroneal nerve D. It provides cutaneous sensation to the posterior aspect of the thigh E. It provides cutaneous sensation to the entire lower leg with the exception of its medial aspect

Answer 116

It contains nerve roots from the posterior division of the lumbosacral plexus onlyIt is derived from both anterior and posterior divisions of the lumbosacral plexus. The sciatic nerve is the longest and widest nerve in the human body. It is particularly susceptible to trauma in the posterior approach to the hip.

Question 117

Question 125 of 328 A 28 year old man has a pleomorphic adenoma and the decision is made to resect this surgically. Which of the following structures is least likely to be encountered during surgical resection of the parotid gland? A. External carotid artery B. Retromandibular vein C. Auriculotemporal nerve D. Mandibular nerve E. Zygomatic branch of the facial nerve

Answer 117

Mandibular nerveStructures passing through the parotid gland Facial nerve and branches External carotid artery (and its branches; the maxillary and superficial temporal) Retromandibular vein Auriculotemporal nerveThe mandibular nerve is well separated from the parotid gland.The maxillary vein joins to the superficial temporal vein and they form the retromandibular vein which then runs through the parotid gland.The auriculotemporal nerve runs through the gland. Following a parotidectomy this nerve may be damaged and during neuronal regrowth may then attach to sweat glands in this region. This can then cause gustatory sweating (Freys Syndrome).

Question 118

Question 126 of 328 During a radical thyroidectomy for carcinoma the surgeons inadvertently damage the ansa cervicalis nerve. Which of the muscles below is most likely to be affected? A. Mylohyoid muscle B. Palatopharyngeus muscle C. Thyrohyoid muscle D. Geniohyoid muscle E. Sternothyroid muscle

Answer 118

Sternothyroid muscleThe ansa cervicalis is derived from nerve roots C1, C2, C3 and is a nerve loop that accompanies the internal jugular vein. It innervates sternohyoid, thyrohyoid, sternothyroid and omohyoid. Geniohyoid is innervated from the C1 root via the hypoglossal nerve, as is thyroidhyoid. Mylohyoid is innervated from the mylohyoid branch of the inferior alveolar nerve. Palatopharyngeus is innervated by the pharyngeal plexus.

Question 119

Question 127 of 328 A 23 year old man is undergoing an hernia repair and the mesh is to be sutured to the inguinal ligament. From which of the following does the inguinal ligament arise? A. Transversus abdominis fascia B. Internal oblique C. Rectus sheath D. Rectus abdominis muscle E. External oblique aponeurosis

Answer 119

The inguinal ligament is formed by the external oblique aponeurosis. It runs from the pubic tubercle to the anterior superior iliac spine.

Question 120

Question 128 of 328 A 56 year old man is undergoing a carotid endarterectomy. The internal carotid artery is mobilised. How many branches does this vessel give off in the neck? A. 0 B. 1 C. 2 D. 3 E. 6

Answer 120

0

Question 121

Question 129 of 328 Which of the following is a content of the adductor canal? A. Saphenous nerve B. Sural nerve C. Femoral nerve D. Profunda branch of the femoral artery E. Saphenous vein

Answer 121

It contains the saphenous nerve and the superficial branch of the femoral artery.

Question 122

Question 130 of 328 A 56 year old man is undergoing a high anterior resection. Which of the following structures is at greatest risk of injury in this procedure? A. Superior mesenteric artery B. Left ureter C. External iliac vein D. External iliac artery E. Inferior vena cava

Answer 122

Left UreterA careless surgeon may damage all of these structures. However, the structure at greatest risk and most frequently encountered is the left ureter.

Question 123

Question 131 of 328 From which of these foraminae does the opthalmic branch of the trigeminal nerve exit the skull? A. Foramen ovale B. Foramen rotundum C. Foramen spinosum D. Superior orbital fissure E. Foramen magnum

Answer 123

Superior orbital fissureMnemonic:Standing Room Only -Exit of branches of trigeminal nerve from the skullV1 -Superior orbital fissureV2 -foramen RotundumV3 -foramen OvaleThe opthalmic branch of the trigeminal nerve exits the skull through the superior orbital fissure.

Question 124

Question 132 of 328 A 56 year old lady with metastatic breast cancer develops an oestolytic deposit in the proximal femur. One morning whilst getting out of bed she notices severe groin pain. X-rays show that the lesser trochanter has been avulsed. Which muscle is the most likely culprit? A. Vastus lateralis B. Psoas major C. Piriformis D. Gluteus maximus E. Gluteus medius

Answer 124

The psoas major inserts into the lesser trochanter and contracts when raising the trunk from the supine position. When oestolytic lesions are present in the femur the lesser trochanter may be avulsed.

Question 125

Question 133 of 328 Which of the following nerves is responsible for the motor innervation of the sternocleidomastoid muscle? A. Ansa cervicalis B. Accessory nerve C. Hypoglossal nerve D. Facial nerve E. Vagus nerve

Answer 125

Theme from January 2013 ExamThe motor supply to the sternocleidomastoid is from the accessory nerve. The ansa cervicalis supplies sensory information from the muscle.

Question 126

Question 134 of 328 A 42 year old lady undergoes a difficult cholecystectomy and significant bleeding is occurring. The surgeons place a vascular clamp transversely across the anterior border of the epiploic foramen. Which of the following structures will be occluded in this manoeuvre? A. Cystic artery B. Cystic duct C. Left gastric artery D. Portal vein E. None of the above

Answer 126

The portal vein, hepatic artery and common bile duct are occluded.

Question 127

Question 135 of 328 A 34 year old man is injured by farm machinery and sustains a laceration at the superolateral aspect of the popliteal fossa. The medial aspect of biceps femoris is lacerated. Which of the following underlying structures is at greatest risk of injury? A. Gracilis B. Sural nerve C. Nerve to semimembranosus D. Popliteal artery E. Common peroneal nerve

Answer 127

Common peroneal nerveThe common peroneal nerve lies under the medial aspect of biceps femoris and is therefore at greatest risk of injury. The tibial nerve may also be damaged in such an injury (but is not listed here). The sural nerve branches off more inferiorly.

Question 128

Question 136 of 328 A 56 year old lady undergoes a Hartmans style resection of the sigmoid colon, with ligation of the vessels close to the colon. Which of the following vessels will be responsible to supplying the rectal stump directly? A. Superior mesenteric artery B. Middle colic artery C. Superior rectal artery D. Inferior mesenteric artery E. External iliac artery

Answer 128

Superior rectal arteryThis question is addressing the blood supply to the rectum. Which is supplied by the superior rectal artery. High ligation of the IMA may compromise this structure. However, the question states that during the Hartmans procedure the vessels were ligated close to the bowel. Implying that the superior rectal was preserved.

Question 129

Question 137 of 328 Which of the nerves listed below is at greatest risk of injury with a laceration to the upper lateral margin of the popliteal fossa? A. Common peroneal nerve B. Sural nerve C. Sciatic nerve D. Saphenous nerve E. Tibial nerve

Answer 129

Common peroneal nerveThe sural nerve exits at the lower latero-medial aspect of the fossa and is more at risk in short saphenous vein surgery. The tibial nerve lies more medially and is even less likely to be injured in this location.

Question 130

Question 138 of 328 Which option is false in relation to the trigeminal nerve? A. The nerve originates at the pons B. The posterior scalp is supplied by the trigeminal nerve C. The maxillary nerve exits via the foramen rotundum D. The maxillary nerve is purely sensory E. The motor root is not in the trigeminal ganglion

Answer 130

The posterior scalp is supplied by the trigeminal nerveThe posterior scalp is supplied by C2-C3.

Question 131

Question 139 of 328 A 45 year old man is undergoing a lymph node biopsy from the posterior triangle of his neck. Which structure forms the posterior border of this region? A. Trapezius muscle B. Diagastric muscle C. External jugular vein D. Omohyoid muscle E. Sternocleidomastoid muscle

Answer 131

Trapezius muscle

Question 132

Question 140 of 328 On inspecting the caecum, which of the following structures is most likely to be identified at the point at which all the tenia coli converge? A. Gonadal vessels B. Appendix base C. Appendix tip D. Ileocaecal valve E. Ileocolic artery

Answer 132

Appendix baseThe tenia coli converge at the base of the appendix.

Question 133

Question 141 of 328 A 42 year old lady has had an axillary node clearance for breast malignancy. Post operatively she reports weakness of the shoulder. She is unable to push herself forwards from a wall with the right arm and the scapula is pushed out medially from the chest wall. What is the most likely nerve injury? A. C5, C6 B. C8, T1 C. Axillary nerve D. Long thoracic nerve E. Spinal accessory nerve

Answer 133

Long thoracic nerveTheme from January 2012 and 2009 ExamThe patient has a winged scapula caused by damage to the long thoracic nerve (C5,6,7) during surgery. The long thoracic nerve innervates serratus anterior. Serratus anterior causes pushing out of the scapula during a punch.NB winging of the scapular laterally may indicate trapezius muscle weakness. Innervated by the spinal accessory nerve.

Question 134

Question 142 of 328 A 36 year old male is admitted for elective surgery for a lymph node biopsy in the supraclavicular region. Post operatively the patient has difficulty shrugging his left shoulder. What is the most likely reason? A. Phrenic nerve lesion B. Axillary nerve lesion C. C5, C6 root lesion D. C8, T1 root lesion E. Accessory nerve lesion

Answer 134

Accessory nerve lesionTheme from September 2011 ExamTheme from September 2013 ExamThe accessory nerve lies in the posterior triangle and may be injured in this region. Apart from problems with shrugging the shoulder, he may also have difficulty lifting his arm above his head.

Question 135

Question 143 of 328 How many fissures are present within the right lung? A. One B. Three C. Two D. Four E. Five

Answer 135

2The right lung has an oblique and horizontal fissure. The upper oblique fissure separates the inferior from the middle and upper lobes. The short horizontal fissure separates the superior and middle lobes.

Question 136

Question 144 of 328 Which of the following muscles is supplied by the musculocutaneous nerve? A. Brachialis B. Latissimus dorsi C. Flexor carpi ulnaris D. Teres minor E. Triceps

Answer 136

BrachialisMnemonicMuscles innervated by the musculocutaneous nerve BBC:Biceps brachiiBrachialisCoracobrachialis

Question 137

Question 145 of 328 Which of the following statements relating to the posterior cerebral artery is false? A. It supplies the visual cortex B. It is closely related to the 3rd cranial nerve C. It is a branch of the basilar artery D. It is connected to the circle of Willis via the superior cerebellar artery E. When occluded may result in contralateral loss of field of vision

Answer 137

It is connected to the circle of Willis via the superior cerebellar arteryThe posterior cerebral arteries are formed by the bifurcation of the basilar artery and is connected to the circle of Willis via the posterior communicating artery.The posterior cerebral arteries supply the occipital lobe and part of the temporal lobe.

Question 138

Question 146 of 328 An elderly lady falls and lands on her hip. On examination her hip is tender to palpation and x-rays are taken. There are concerns that she may have an intertrochanteric fracture. What is the normal angle between the femoral neck and the femoral shaft? A. 90o B. 105o C. 80o D. 130o E. 180o

Answer 138

130The normal angle between the femoral head and shaft is 130o. Changes to this angle may occur as a result of disease or pathology and should be investigated.

Question 139

Question 147 of 328 A 17 year old male presents to the clinic. He complains of difficulty using his left hand. It has been a persistent problem since he sustained a distal humerus fracture as a child. On examination there is diminished sensation overlying the hypothenar eminence and medial one and half fingers. What is the most likely nerve lesion? A. Anterior interosseous nerve B. Posterior interosseous nerve C. Ulnar nerve D. Median nerve E. Radial nerve

Answer 139

Ulnar nerveTheme from April 2012 ExamThis sensory deficit pattern is most consistent with ulnar nerve injury.

Question 140

Question 148 of 328 An 18 year old athlete attends orthopaedic clinic reporting pain and swelling over the medial aspect of the knee joint. The pain occurs when climbing the stairs, but is not present when walking on flat ground. Clinically there is pain over the medial, proximal tibia and the McMurray test is negative. What is the most likely cause of this patient’s symptoms? A. Anterior cruciate ligament tear B. Prepatellar bursitis C. Medial meniscus injury D. Pes Anserinus Bursitis E. Fracture of tibia

Answer 140

Pes Anserinus BursitisPes anserinus: GOOSE’S FOOTCombination of sartorius, gracilis and semitendinous tendons inserting into the anteromedial proximal tibia.Pes Anserinus Bursitis is common in sportsmen due to overuse injuries. The main sign is of pain in the medial proximal tibia. As the McMurray test is negative, medial meniscal injury is excluded.

Question 141

Question 149 of 328 Which of the following structures lies most posteriorly at the porta hepatis? A. Cystic artery B. Common hepatic artery C. Left hepatic artery D. Portal vein E. Common bile duct

Answer 141

The portal vein is the most posterior structure at the porta hepatis.The common bile duct is a continuation of the common hepatic duct and is formed by the union of the common hepatic duct and the cystic duct.

Question 142

Question 150 of 328 A 76 year old man is undergoing an abdominal aortic aneurysm repair. The surgeons occlude the aorta with two clamps, the inferior clamp being placed at the point of aortic bifurcation. Which of the following vertebral bodies will lie posterior to the clamp at this level? A. L1 B. T10 C. L4 D. L5 E. L2

Answer 142

L4Theme from September 2013 ExamThe aorta bifurcates at L4. An important landmark that is tested frequently.

Question 143

Question 151 of 328 Which of the following statements relating to the greater omentum is false? A. It is less well developed in children under 5. B. It has no relationship to the lesser sac. C. It contains the gastroepiploic arteries. D. Has an attachment to the transverse colon. E. It may be a site of metastatic disease in ovarian cancer.

Answer 143

It has no relationship to the lesser sac.It is connected with the lesser sac and the transverse colon. This plane is entered when performing a colonic resection. It is a common site of metastasis in many visceral malignancies.

Question 144

Question 152 of 328 A 48 year old man with newly diagnosed hypertension is found to have a phaeochromocytoma of the left adrenal gland and is due to undergo a laparoscopic left adrenalectomy. Which of the following structures is not directly related to the left adrenal gland? A. Crus of the diaphragm B. Lesser curvature of the stomach C. Kidney D. Pancreas E. Splenic artery

Answer 144

Lesser curvature of the stomachThe left adrenal gland is slightly larger than the right. It is crescent in shape and its concavity is adapted to the medial border of the upper part of the left kidney. The upper area is covered by peritoneum of the omental bursa which separates it from the cardia of the stomach. The lower area is in contact with the pancreas and splenic artery and is not covered by peritoneum. On the anterior surface is a hilum from which the suprarenal vein emerges. The lateral aspect rests on the kidney. The medial is small and is on the left crus of the diaphragm.

Question 145

Question 153 of 328 Which of the following nerves innervates the long head of the biceps femoris muscle? A. Inferior gluteal nerve B. Tibial nerve C. Superior gluteal nerve D. Common peroneal nerve E. Obturator nerve

Answer 145

Tibial nerveThe short head of biceps femoris, which may occasionally be absent, is innervated by the common peroneal component of the sciatic nerve. The long head is innervated by the tibial nerve.

Question 146

Question 154 of 328 A 72 year old male with end stage critical ischaemia is undergoing an axillo-femoral bypass. What structure is not closely related to the axillary artery? A. Posterior cord of the brachial plexus B. Scalenus anterior muscle C. Pectoralis minor muscle D. Axillary vein E. Lateral cord of the brachial plexus

Answer 146

Scalenus anterior muscleThe axillary artery is the continuation of the subclavian artery. It is surrounded by the cords of the brachial plexus (from which they are named). The axillary vein runs alongside the axillary artery throughout its length.

Question 147

Question 155 of 328 A 28 year old man is shot in the right chest and develops a right haemothorax necessitating a thoracotomy. The surgeons decide to place a vascular clamp across the hilum of the right lung. Which of the following structures will lie most anteriorly at this point? A. Thoracic duct B. Phrenic nerve C. Vagus nerve D. Pulmonary artery E. Pulmonary vein

Answer 147

The phrenic nerve lies anteriorly at the root of the right lung.

Question 148

Question 156 of 328 An 18 year old boy is undergoing an appendicectomy for appendicitis. At which of the following locations is the appendix most likely to be found? A. Pre ileal B. Pelvic C. Retrocaecal D. Post ileal E. None of the above

Answer 148

RetrocaecalMost appendixes lie in the retrocaecal position. If a retrocaecal appendix is difficult to remove then mobilisation of the right colon significantly improves access.

Question 149

Question 157 of 328 A 56 year old man is undergoing a pancreatectomy for carcinoma. During resection of the gland which of the following structures will the surgeon not encounter posterior to the pancreas itself? A. Left crus of the diaphragm B. Superior mesenteric vein C. Common bile duct D. Portal vein E. Gastroduodenal artery

Answer 149

Gastroduodenal arteryTheme from 2010 ExamThe gastroduodenal artery lies anterior to the pancreas.

Question 150

Question 158 of 328 Which of the following bones is related to the cuboid at its distal articular surface? A. All metatarsals B. 5th metatarsal C. Calcaneum D. Medial cuneiform E. 3rd metatarsal

Answer 150

5th metatarsalTheme from April 2012 ExamThe cuboid is located at the lateral aspect of the foot between the calcaneus posteriorly and the 4th and 5th metatarsals distally.

Question 151

Question 159 of 328 From which structure is the central tendon of the diaphragm derived? A. Septum transversum B. Pleuroperitoneal folds C. Diaphragmatic crura D. Dorsal mesocardium E. Oropharyngeal membrane

Answer 151

Septum transversumThe septum transversum is a thick ridge of mesodermal tissue in the developing embryo that separates the thoracic and abdominal cavities and forms the central tendon of the diaphragm.

Question 152

Question 160 of 328 Where does Stensens duct primarily open? A. Immediately lateral to the foramen caecum B. Floor of mouth C. Opposite the second molar tooth D. Opposite the fifth molar tooth E. Into the post nasal space

Answer 152

Opposite the second molar toothStensens duct conveys secretions from the parotid gland and these enter the oral cavity at the level of the second molar tooth.

Question 153

Question 161 of 328 Which of the following nerves is responsible for the innervation of the posterior belly of the digastric muscle? A. Facial nerve B. Hypoglossal nerve C. Trigeminal nerve D. Ansa cervicalis E. Mylohoid nerve

Answer 153

Facial nerveThe posterior belly of digastric is innervated by the facial nerve and the anterior belly by the mylohoid nerve.

Question 154

Question 162 of 328 Which of the following carpal bones is a sesamoid bone in the tendon of flexor carpi ulnaris? A. Triquetrum B. Lunate C. Pisiform D. Scaphoid E. Capitate

Answer 154

PisiformThis small bone has a single articular facet. It projects from the triquetral bone at the ulnar aspect of the wrist where most regard it as a sesamoid bine lying within the tendon of flexor carpi ulnaris.

Question 155

Question 163 of 328 A 70 year old man falls and fractures his scaphoid bone. The fracture is displaced and the decision is made to insert a screw to fix the fracture. Which of the following structures lies directly medial to the scaphoid? A. Lunate B. Pisiform C. Trapezoid D. Trapezium E. None of the above

Answer 155

LunateThe lunate lies medially in the anatomical plane. Fractures of the scaphoid that are associated with high velocity injuries may cause associated lunate dislocation.

Question 156

Question 164 of 328 A 55 year old man is admitted with a brisk haematemesis. He is taken to the endoscopy department and an upper GI endoscopy is performed by the gastroenterologist. He identifies an ulcer on the posterior duodenal wall and spends an eternity trying to control the bleeding with all the latest haemostatic techniques. He eventually asks the surgeons for help. A laparotomy and anterior duodenotomy are performed, as the surgeon opens the duodenum a vessel is spurting blood into the duodenal lumen. From which of the following does this vessel arise? A. Left gastric artery B. Common hepatic artery C. Right hepatic artery D. Superior mesenteric artery E. Splenic artery

Answer 156

Common hepatic arteryThe vessel will be the gastroduodenal artery, this arises from the common hepatic artery.

Question 157

Question 165 of 328 A 73 year old lady is hit by a car. She suffers a complex fracture of the distal aspect of her humerus with associated injury to the radial nerve. Which of the following movements will be most impaired as a result? A. Elbow extension B. Elbow flexion C. Shoulder abduction D. Wrist extension E. None of the above

Answer 157

Wrist extensionThe triceps will not be affected so elbow extension will be preserved. Loss of wrist extension will be the most obvious effect.

Question 158

Question 166 of 328 Which of the following is not a content of the rectus sheath? A. Pyramidalis B. Superior epigastric artery C. Inferior epigastric vein D. Internal iliac artery E. Rectus abdominis

Answer 158

Internal iliac arteryThe rectus sheath also contains:superior epigastric veininferior epigastric artery

Question 159

Question 167 of 328 Which of the following vessels does not drain directly into the inferior vena cava? A. Superior mesenteric vein B. Right common iliac C. Right hepatic vein D. Left hepatic vein E. Right testicular vein

Answer 159

Superior mesenteric veinThe superior mesenteric vein drains into the portal vein. The right and left hepatic veins drain into it directly, this can account for major bleeding in more extensive liver shearing type injuries.

Question 160

Question 168 of 328 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? A. Visceral layer of the tunica vaginalis B. Cremasteric fascia C. Parietal layer of the tunica vaginalis D. External spermatic fascia E. Internal spermatic fascia

Answer 160

External spermatic fasciaThe layers that will be encountered are (in order):1. Skin2. Dartos fascia and muscle3. External spermatic fascia4. Cremasteric muscle and fascia5. Internal spermatic fascia6. Parietal layer of the tunica vaginalisThe layers of the spermatic cord and scrotum are a popular topic in the MRCS exam.

Question 161

Question 169 of 328 A 25 year old man is stabbed in the groin and the area, which lies within the femoral triangle is explored. Which structure forms the lateral wall of the femoral triangle? A. Adductor longus B. Pectineus C. Adductor magnus D. Sartorius E. Conjoint tendon

Answer 161

The sartorius forms the lateral wall of the femoral triangle (see below).

Question 162

Question 170 of 328 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? A. The hook of hamate B. Median nerve C. Superficial palmar arterial arch D. Digital nerves arising from the ulnar nerve E. None of the above

Answer 162

Median nerveThe flexor digiti minimi brevis originates from the Hamate, on its undersurface 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.

Question 163

Question 171 of 328 A 19 year old man undergoes an open inguinal hernia repair. The cord is mobilised and the deep inguinal ring identified. Which of the following structures forms its lateral wall? A. External oblique aponeurosis B. Transversalis fascia C. Conjoint tendon D. Inferior epigastric artery E. Inferior epigastric vein

Answer 163

The transversalis fascia forms the superolateral edge of the deep inguinal ring. The epigastric vessels form its inferomedial wall.

Question 164

Question 172 of 328 A 22 year old man develops an infection in the pulp of his little finger. What is the most proximal site to which this infection may migrate? A. The metacarpophalangeal joint B. The distal interphalangeal joint C. The proximal interphalangeal joint D. Proximal to the flexor retinaculum E. Immediately distal to the carpal tunnel

Answer 164

Proximal to the flexor retinaculumThe 5th tendon sheath extends from the little finger to the proximal aspect of the carpal tunnel. This carries a significant risk of allowing infections to migrate proximally.

Question 165

Question 173 of 328 Which of the following muscles is not innervated by the deep branch of the ulnar nerve? A. Adductor pollicis B. Hypothenar muscles C. All the interosseous muscles D. Opponens pollicis E. Third and fourth lumbricals

Answer 165

. Opponens pollicis

Question 166

Question 174 of 328 During an inguinal hernia repair the surgeon identifies a small nerve whilst mobilising the cord structures at the level of the superficial inguinal ring. Which nerve is this most likely to be? A. Subcostal B. Iliohypogastric C. Ilioinguinal D. Obturator E. Pudendal

Answer 166

IlioinguinalIlioinguinal nerve entrapment may be a cause of neuropathic pain following inguinal hernia surgery.The ilioinguinal nerve passes through the superfical inguinal ring and is routinely encountered when exploring the inguinal canal during hernia surgery. The iliohypogastric nerve pierces the aponeurosis of the external oblique muscle superior to the superficial inguinal ring.

Question 167

Question 175 of 328 Onto which of the following structures does the anterior cruciate ligament insert? A. Posterolateral aspect of the lateral femoral condyle B. Posteromedial aspect of the lateral femoral condyle C. Posterolateral aspect of the medial femoral condyle D. Posteromedial aspect of the medial femoral condyle E. None of the above

Answer 167

Posteromedial aspect of the lateral femoral condyleThe anterior cruciate ligament is attached to the anterior intercondylar area of the tibia. Is then passes posterolaterally to insert into the posteromedial aspect of the lateral femoral condyle.

Question 168

Question 176 of 328 During an arch aortogram the brachiocephalic artery is entered with an angiography catheter. The radiologist continues to advance the catheter. Into which of the following vessels is it likely to enter? A. Left subclavian artery B. Left axillary artery C. Right subclavian artery D. Right axillary artery E. None of the above

Answer 168

Right subclavian artery The axillary artery is a branch of the subclavian artery and although developmental anomalies may occur they are rare. The catheter may also enter the right carotid. There is no brachiocephalic artery on the left side.

Question 169

Question 177 of 328 Which of the following structures lie between the lateral and medial heads of the triceps muscle? A. Radial nerve B. Median nerve C. Ulnar nerve D. Axillary nerve E. Medial cutaneous nerve of the forearm

Answer 169

The radial nerve runs in its groove on between the two heads. The ulnar nerve lies anterior to the medial head. The axillary nerve passes through the quadrangular space. This lies superior to lateral head of the triceps muscle and thus the lateral border of the quadrangular space is the humerus. Therefore the correct answer is the radial nerve.

Question 170

Question 178 of 328 Into which of the following structures does the superior part of the fibrous capsule of the shoulder joint insert? A. The surgical neck of the humerus B. The body of the humerus C. The bicipital groove D. Immediately distal to the greater tuberosity E. The anatomical neck of the humerus

Answer 170

The anatomical neck of the humerusThe 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

Question 171

Question 179 of 328 A 34 year old lady presents with symptoms of faecal incontinence. Ten years previously she gave birth to a child by normal vaginal delivery. Injury to which of the following nerves is most likely to account for this process? A. Genitofemoral B. Ilioinguinal C. Pudendal D. Hypogastric autonomic nerve E. Obturator

Answer 171

PudendalS2,3,4 keeps the poo up off the floor - POOdendal nerveTheme from April 2012 ExamDamage to the pudendal nerve is classically associated with faecal incontinence and it is for this reason that sacral neuromodulation is a popular treatment for the condition. Injury to the hypogastric autonomic nerves is an aetiological factor in the development of constipation.

Question 172

Question 180 of 328 During a difficult thyroidectomy haemorrhage is noted from the thyroidea ima vessel. From which structure does this vessel usually arise? A. External carotid artery B. Internal carotid artery C. Brachiocephalic artery D. Axillary artery E. Superior thyroid artery

Answer 172

Brachiocephalic arteryRhyme isthmus location:Rings 2,3,4 make the isthmus floorThis accessory vessel which usually lies at the inferior aspect of the gland is derived either from the brachiocephalic artery or the arch of the aorta.

Question 173

Question 181 of 328 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? A. Sciatic nerve injury B. Damage to the internal iliac artery C. Damage to the nervi erigentes D. Damage to the vas E. Damage to the genitofemoral nerve

Answer 173

Damage to the nervi erigentesTheme from 2012 ExamThe 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.

Question 174

Question 182 of 328 The cephalic vein pierces the clavipectoral fascia to terminate in which of the veins listed below? A. External jugular B. Axillary C. Internal jugular D. Azygos E. Brachial

Answer 174

Axillary

Question 175

Question 183 of 328 A 43 year old lady develops a cerebello-pontine angle lesion. Which of the nerves listed below is likely to be affected first? A. CN X B. CN III C. CN V D. CN IX E. CN XII

Answer 175

5Theme from September 2013 ExamThe most likely lesion to occur in the cerebello-pontine angle is an acoustic neuroma.The trigeminal nerve has a broad base and involvement of at least part of this nerve is the most likely initial finding. The defect may be subtle such as loss of the ipsilateral corneal reflex. Ipsilateral hearing loss will also occur. Untreated, progressive lesions, may ultimately affect may cranial nerve roots in this region.

Question 176

Question 184 of 328 Which of the following is not a branch of the descending abdominal aorta? A. Inferior mesenteric artery B. Inferior phrenic artery C. Superior mesenteric artery D. Superior phrenic artery E. Renal artery

Answer 176

Superior phrenic arteryMnemonic for the Descending abdominal aorta branches from diaphragm to iliacs:’Prostitutes Cause Sagging Swollen Red Testicles [in men] Living In Sin’:Phrenic [inferior]CeliacSuperior mesentericSuprarenal [middle]RenalTesticular [‘in men’ only]LumbarsInferior mesentericSacralThe superior phrenic artery branches from the aorta in the thorax.

Question 177

Question 185 of 328 A 40 year old lady presents with varicose veins, these are found to originate from the short saphenous vein. As the vein is mobilised close to its origin which structure is at greatest risk of injury? A. Sciatic nerve B. Sural nerve C. Common peroneal nerve D. Tibial nerve E. Popliteal artery

Answer 177

The sural nerve is closely related and damage to this structure is a major cause of litigation. The other structures may all be injured but the risks are lower.

Question 178

Question 186 of 328 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? A. The tips of the transverse processes between L2 and L5 B. The tips of transverse processes between T10-L1 C. At the crest of the ilium D. Over the S3 foramina E. Over the sacrococcygeal joint

Answer 178

The tips of the transverse processes between L2 and L5The 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.

Question 179

Question 187 of 328 Damage to the posterior cord of the brachial plexus will not result in any of the following except: A. Klumpkes palsy B. Anaesthesia overlying the lateral aspect of the forearm C. A warm sweaty hand on the affected side D. Loss of flexion of the arm E. Anaesthesia overlying the posterior surface of the arm

Answer 179

Anaesthesia overlying the posterior surface of the armThe radial nerve gives cutaneous branches which supply the forearm posteriorly and the arm laterally. Division of the posterior cord will impair the upper level of cutaneous sensation. However, the lateral cutaneous nerve of the forearm arises from the musculocutaneous nerve and would be unaffected. Loss of sympathetic function, from the posterior cord alone, would not result in a sweaty hand. Klumpkes palsy occurs when the lower roots are C8-T1 are damaged.

Question 180

Question 188 of 328 A 72 year old man with non reconstructible arterial disease is undergoing an above knee amputation. The posterior compartment muscles are divided. Which of the following muscles does not lie in the posterior compartment of the thigh? A. Biceps femoris B. Quadriceps femoris C. Semitendinosus D. Semimembranosus E. None of the above

Answer 180

Quadriceps femorisThe quadriceps femoris lies in the anterior compartment.

Question 181

Question 189 of 328 A woman develops winging of the scapula following a Patey mastectomy. What is the most likely cause? A. Division of pectoralis minor to access level 3 axillary nodes B. Damage to the brachial plexus during axillary dissection C. Damage to the long thoracic nerve during axillary dissection D. Division of the thoracodorsal trunk during axillary dissection E. Damage to the thoracodorsal trunk during axillary dissection

Answer 181

Damage to the long thoracic nerve during axillary dissection

Question 182

Question 190 of 328 In a patient with an ectopic kidney where is the adrenal gland most likely to be located? A. In the pelvis B. On the contralateral side C. In its usual position D. Superior to the spleen E. It will be absent

Answer 182

In its usual position

Question 183

Question 191 of 328 Which of the following structures is not closely related to the posterior tibial artery? A. Soleus posteriorly B. Tibial nerve medially C. Deep peroneal nerve laterally D. Flexor hallucis longus postero-inferiorly E. Popliteus

Answer 183

Deep peroneal nerve laterallyThe deep peroneal nerve lies in the anterior compartment. The tibial nerve lies medially. At its termination it lies deep to the flexor retinaculum.

Question 184

Question 192 of 328 Which of the following is not closely related to the capitate bone? A. Lunate bone B. Scaphoid bone C. Ulnar nerve D. Hamate bone E. Trapezoid bone

Answer 184

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.

Question 185

Question 193 of 328 Which of the following statements relating to the tympanic membrane is false? A. The umbo marks the point of attachment of the handle of the malleus to the tympanic membrane B. The lateral aspect of the tympanic membrane is lined by stratified squamous epithelium C. The chorda tympani nerve runs medial to the pars tensa D. The medial aspect of the tympanic membrane is lined by mucous membrane E. The tympanic membrane is approximately 1cm in diameter

Answer 185

The chorda tympani nerve runs medial to the pars tensaThe chorda tympani runs medially to the pars flaccida. The relationship is shown from the medial aspect in the dissection below.

Question 186

Question 194 of 328 An injury to the spinal accessory nerve will affect which of the following movements? A. Lateral rotation of the arm B. Adduction of the arm at the glenohumeral joint C. Protraction of the scapula D. Upward rotation of the scapula E. Depression of the scapula

Answer 186

Upward rotation of the scapulaThe spinal accessory nerve innervates trapezius. The entire muscle will retract the scapula. However, its upper and lower fibres act together to upwardly rotate it.

Question 187

Question 195 of 328 Which of the following is not contained within the middle mediastinum? A. Main bronchi B. Arch of the azygos vein C. Thoracic duct D. Pericardium E. Aortic root

Answer 187

Thoracic ductThe thoracic duct lies within the posterior and superior mediastinum.

Question 188

Question 196 of 328 A 55 year old man is due to undergo a radical prostatectomy for carcinoma of the prostate gland. Which of the following vessels directly supplies the prostate? A. External iliac artery B. Common iliac artery C. Internal iliac artery D. Inferior vesical artery E. None of the above

Answer 188

Inferior vesical arteryThe arterial supply to the prostate gland is from the inferior vesical artery, it is a branch of the prostatovesical artery. The prostatovesical artery usually arises from the internal pudendal and inferior gluteal arterial branches of the internal iliac artery.

Question 189

Question 197 of 328 Which nerve directly innervates the sinoatrial node? A. Superior cardiac nerve B. Right vagus nerve C. Left vagus nerve D. Inferior cardiac nerve E. None of the above

Answer 189

None of the aboveTheme from September 2011 ExamTheme from September 2012 ExamNo 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.

Question 190

Question 198 of 328 A 30 year old man presents with back pain and the surgeon tests the ankle reflex. Which of the following nerve roots are tested in this manoeuvre? A. S3 and S4 B. L4 and L5 C. L3 and L4 D. S1 and S2 E. S4 only

Answer 190

S1 and S2(2012 exam)

Question 191

Question 199 of 328 Which of the following structures is not closely related to the piriformis muscle? A. Superior gluteal nerve B. Sciatic nerve C. Inferior gluteal artery D. Inferior gluteal nerve E. Medial femoral circumflex artery

Answer 191

Medial femoral circumflex arteryNerve supply of lateral hip rotatorsPiriformis: ventral rami S1, S2Obturator internus: nerve to obturator internusSuperior gemellus: nerve to obturator internusInferior gemellus: nerve to quadratus femorisQuadrator femoris: nerve to quadrator femorisThe piriformis muscle is an important anatomical landmark in the gluteal region. The following structures are closely related: Sciatic nerve Inferior gluteal artery and nerve Superior gluteal artery and nerveThe medial femoral circumflex artery runs deep to quadratus femoris.

Question 192

Question 200 of 328 An 18 year old male presents to casualty with a depressed skull fracture. This is managed surgically. Over the next few days he complains of double vision on walking down stairs and reading. On examination the left eye faces downwards and medially. Which of the nerves listed below is most likely to be responsible? A. Facial B. Oculomotor C. Abducens D. Trochlear E. Trigeminal nerve

Answer 192

Theme from September 2012 ExamThe trochlear nerve has a relatively long intracranial course and this makes it vulnerable to injury in head trauma. Head trauma is the commonest cause of an acute fourth nerve palsy. The affected eye typically drifts upwards compared to the normal eye. A 4th nerve palsy is the commonest cause of a vertical diplopia. Looking down and in is difficult and the patient notices diplopia on descending the stairs.

Question 193

Question 201 of 328 A 77 year old man with symptoms of intermittent claudication is due to have his ankle brachial pressure indices measured. The dorsalis pedis artery is impalpable. Which of the following tendinous structures lies medial to it, that may facilitate its identification? A. Extensor digitorum longus tendon B. Peroneus tertius tendon C. Extensor hallucis longus tendon D. Extensor digitorum brevis tendon E. Flexor digitorum longus tendon

Answer 193

The extensor hallucis longus tendon lies medial to the dorsalis pedis artery.

Question 194

Question 202 of 328 A 23 year old man falls over whilst intoxicated and a shard of glass transects his median nerve at the proximal border of the flexor retinaculum. His tendons escape injury. Which of the following features is least likely to be present? A. Weakness of thumb abduction B. Loss of sensation on the dorsal aspect of the thenar eminence C. Loss of power of opponens pollicis D. Adduction and lateral rotation of the thumb at rest E. Loss of power of abductor pollicis brevis

Answer 194

Loss of sensation on the dorsal aspect of the thenar eminenceThe median nerve may be injured proximal to the flexor retinaculum. This will result in loss of flexor pollicis brevis, opponens pollicis and the first and second lumbricals. When the patient is asked to close the hand slowly there is a lag of the index and middle fingers reflecting the impaired lumbrical muscle function. The sensory changes are minor and do not extend to the dorsal aspect of the thenar eminence.Abductor pollicis longus will contribute to thumb abduction (and is innervated by the posterior interosseous nerve) and therefore abduction will be weaker than prior to the injury.

Question 195

Question 203 of 328 The following muscles are supplied by the recurrent laryngeal nerve except: A. Transverse arytenoid B. Posterior crico-arytenoid C. Cricothyroid D. Oblique arytenoid E. Thyroarytenoid

Answer 195

CricothyroidInnervates: all intrinsic larynx muscles (excluding cricothyroid)The external branch of the superior laryngeal nerve innervates the cricothyroid muscle.

Question 196

Question 204 of 328 From which embryological structure is the ureter derived? A. Uranchus B. Cloaca C. Vitello-intestinal duct D. Mesonephric duct E. None of the above

Answer 196

The ureter develops from the mesonephric duct.

Question 197

Question 205 of 328 A 16 year old boy is hit by a car and sustains a blow to the right side of his head. He is initially conscious but on arrival in the emergency department is comatose. On examination his right pupil is fixed and dilated. The neurosurgeons plan immediate surgery. What type of initial approach should be made? A. Left parieto-temporal craniotomy B. Right parieto-temporal craniotomy C. Posterior fossa craniotomy D. Left parieto-temporal burr holes E. None of the above

Answer 197

Right parieto-temporal craniotomyTheme from April 2012 ExamA unilateral dilated pupil is a classic sign of transtentorial herniation. The medial aspect of the temporal lobe (uncus) herniates across the tentorium and causes pressure on the ipsilateral oculomotor nerve, interrupting parasympathetic input to the eye and resulting in a dilated pupil. In addition the brainstem is compressed. As the ipsilateral oculomotor nerve is being compressed, craniotomy (rather than Burr Holes) should be made on the ipsilateral side.

Question 198

Question 206 of 328 Which of the following relationship descriptions regarding the scalene muscles is incorrect? A. The brachial plexus passes anterior to the middle scalene muscle B. The phrenic nerve lies anterior to the anterior scalene muscle C. The subclavian artery passes posterior to the middle scalene D. The subclavian vein lies anterior to the anterior scalene muscle at the level of the first rib E. The anterior scalene inserts into the first rib

Answer 198

The subclavian artery passes anterior to the middle scalene.

Question 199

Question 207 of 328 A 56 year old man is having a long venous line inserted via the femoral vein into the right atrium for CVP measurements. The catheter is advanced through the IVC. At which of the following levels does this vessel enter the thorax? A. L2 B. T10 C. L1 D. T8 E. T6

Answer 199

Theme from 2010 ExamTheme from September 2012 ExamThe IVC passes through the diaphragm at T8.

Question 200

Question 208 of 328 A 23 year old man falls and injures his hand. There are concerns that he may have a scaphoid fracture as there is tenderness in his anatomical snuffbox on clinical examination. Which of the following forms the posterior border of this structure? A. Basilic vein B. Radial artery C. Extensor pollicis brevis D. Abductor pollicis longus E. Extensor pollicis longus

Answer 200

Extensor pollicis longusTheme from 2009 ExamTheme from September 2012 ExamIts boundaries are extensor pollicis longus, medially (posterior border) and laterally (anterior border) by the tendons of abductor pollicis longus and extensor pollicis brevis.

Question 201

Question 209 of 328 Which of the following structures attaches periosteum to bone? A. Sharpeys fibres B. Peripheral lamellae C. Elastic fibres D. Fibrolamellar bundles E. Purkinje fibres

Answer 201

Sharpeys fibresPeriosteum 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.

Question 202

Question 210 of 328 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: A. Marginal artery B. Left testicular artery C. Spleen D. Left renal vein E. None of the above

Answer 202

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.

Question 203

Question 211 of 328 A man is undergoing excision of a sub mandibular gland. As the gland is mobilised, a vessel is injured lying between the gland and the mandible. Which of the following is this vessel most likely to be? A. Lingual artery B. Occipital artery C. Superior thyroid artery D. Facial artery E. External jugular vein

Answer 203

Facial arteryThe high salivary viscosity of submandibular gland secretions favors stone formation.Most stones are radio-opaque.The facial artery lies between the gland and mandible and is often ligated during excision of the gland. The lingual artery may be encountered but this is usually later in the operative process as Whartons duct is mobilised.

Question 204

Question 212-214 of 328 Theme: Cranial nervesA. FacialB. TrigeminalC. VagusD. HypoglossalE. GlossopharyngealFor each of the following functions please select the most likely responsible cranial nerve. Each option may be used once, more than once or not at all.212. Supplies the motor fibres of styloglossus.213. Provides sensation to the anterior two thirds of the tongue.214. Supplies general sensation to the posterior third of the tongue.

Answer 204

Question 212-214 of 328 Theme: Cranial nervesA. FacialB. TrigeminalC. VagusD. HypoglossalE. GlossopharyngealFor each of the following functions please select the most likely responsible cranial nerve. Each option may be used once, more than once or not at all.212. Supplies the motor fibres of styloglossus.You answered FacialThe correct answer is HypoglossalThe hypoglossal nerve supplies motor innervation to all extrinsic and intrinsic muscles of the tongue.213. Provides sensation to the anterior two thirds of the tongue.You answered HypoglossalThe correct answer is TrigeminalTaste to the anterior two thirds of the tongue is supplied by the facial nerve, the trigeminal supplies general sensation.214. Supplies general sensation to the posterior third of the tongue.You answered TrigeminalThe correct answer is GlossopharyngealThe glossopharyngeal nerve supplies general sensation to the posterior third of the tongue and contributes to the gag reflex.

Question 205

Question 215 of 328 The integrity of which muscle is assessed by the Trendelenburg test? A. Sartorius B. Quadratus femoris C. Semimembranosus D. Gluteus medius E. Piriformis

Answer 205

Gluteus medius(2011 Exam)

Question 206

Question 216 of 328 A 52 year old female renal patient needs a femoral catheter to allow for haemodialysis. Which of the structures listed below is least likely to be encountered during its insertion? A. Great saphenous vein B. Deep circumflex iliac artery C. Superficial circumflex iliac artery D. Femoral vein E. Femoral branch of the genitofemoral nerve

Answer 206

Deep circumflex iliac arteryFemoral access catheters are typically inserted in the region of the femoral triangle. Therefore the physician may encounter the femoral, vein, nerve, branches of the femoral artery and tributaries of the femoral vein. The deep circumflex iliac artery arises above the inguinal ligament and is therefore less likely to be encountered than the superficial circumflex iliac artery which arises below the inguinal ligament.

Question 207

Question 217 of 328 A 53 year old man with a chronically infected right kidney is due to undergo a nephrectomy. Which of the following structures would be encountered first during a posterior approach to the hilum of the right kidney? A. Right renal artery B. Ureter C. Right renal vein D. Inferior vena cava E. Right testicular vein

Answer 207

The ureter is the most posterior structure at the hilum of the right kidney and would therefore be encountered first during a posterior approach.

Question 208

Question 218 of 328 A 28 year old man is stabbed outside a nightclub in the upper arm. The median nerve is transected. Which of the following muscles will demonstrate impaired function as a result? A. Palmaris brevis B. Second and third interossei C. Adductor pollicis D. Abductor pollicis longus E. Abductor pollicis brevis

Answer 208

Abductor pollicis brevisPalmaris brevis - Ulnar nervePalmar interossei- Ulnar nerveAdductor pollicis - Ulnar nerveAbductor pollicis longus - Posterior interosseous nerveAbductor pollicis brevis - Median nerveThe median nerve innervates all the short muscles of the thumb except the adductor and the deep head of the short flexor. Palmaris and the interossei are innervated by the ulnar nerve.

Question 209

Question 219 of 328 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? A. Middle cerebral artery B. Internal carotid artery C. Anterior cerebral artery D. Maxillary artery E. Mandibular artery

Answer 209

Maxillary arteryThe 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”)

Question 210

Question 220 of 328 A 72 year old man with carcinoma of the lung is undergoing a left pneumonectomy. The left main bronchus is divided. Which of the following thoracic vertebrae lies posterior to this structure? A. T3 B. T7 C. T6 D. T10 E. T1

Answer 210

T6The left main bronchus lies at T6. Topographical anatomy of the thorax is important as it helps surgeons to predict the likely structures to be injured in trauma scenarios (so popular with examiners)

Question 211

Question 221 of 328 Which of the following regions of the male urethra is entirely surrounded by Bucks fascia? A. Preprostatic part B. Prostatic part C. Membranous part D. Spongiose part E. None of the above

Answer 211

Spongiose partTheme from 2010 ExamBucks fascia is a layer of deep fascia that covers the penis it is continuous with the external spermatic fascia and the penile suspensory ligament. The membranous part of the urethra may partially pass through Bucks fascia as it passes into the penis. However, the spongiose part of the urethra is contained wholly within Bucks fascia.

Question 212

Question 222 of 328 Which of the following statements relating to the knee joint is false? A. It is the largest synovial joint in the body B. When the knee is fully extended all ligaments of the knee joint are taut C. Rupture of the anterior cruciate ligament may result in haemarthrosis D. The posterior aspect of the patella is extrasynovial E. The joint is innervated by the femoral, sciatic and obturator nerves

Answer 212

The posterior aspect of the patella is extrasynovialThe 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.

Question 213

Question 223 of 328 A 48 year old lady is undergoing a left sided adrenalectomy for an adrenal adenoma. The superior adrenal artery is injured and starts to bleed, from which of the following does this vessel arise? A. Left renal artery B. Inferior phrenic artery C. Aorta D. Splenic E. None of the above

Answer 213

The superior adrenal artery is a branch of the inferior phrenic artery.

Question 214

Question 224 of 328 Which of the following does not exit the pelvis through the greater sciatic foramen? A. Superior gluteal artery B. Internal pudendal vessels C. Sciatic nerve D. Obturator nerve E. Inferior gluteal nerve

Answer 214

Obturator nerveThe obturator nerve exits through the obturator foramen.

Question 215

Question 225 of 328 Which statement is false about the foramina of the skull? A. The hypoglossal canal transmits the hypoglossal nerve B. The foramen spinosum is at the base of the medial pterygoid plate. C. The jugular foramen transmits the accessory nerve D. The foramen lacerum is located in the sphenoid bone E. The stylomastoid foramen transmits the facial nerve

Answer 215

The foramen spinosum is at the base of the medial pterygoid plate.

Question 216

Question 226 of 328 An 80 year old lady with a caecal carcinoma is undergoing a right hemicolectomy performed through a transverse incision. The procedure is difficult and the incision is extended medially by dividing the rectus sheath. Brisk arterial haemorrhage ensues. From which of the following does the damaged vessel originate? A. Internal iliac artery B. External iliac artery C. Superior vesical artery D. Inferior vesical artery E. None of the above

Answer 216

The vessel damaged is the epigastric artery. This originates from the external iliac artery (see below).

Question 217

Question 227 of 328 A 73 year old man has a large abdominal aortic aneurysm. During a laparotomy for planned surgical repair the surgeons find the aneurysm is far more proximally located and lies near the origin of the SMA. During the dissection a vessel lying transversely across the aorta is injured. What is this vessel most likely to be? A. Left renal vein B. Right renal vein C. Inferior mesenteric artery D. Ileocolic artery E. Middle colic artery

Answer 217

Left renal veinTheme from April 2012 ExamThe left renal vein runs across the surface of the aorta and may require deliberate ligation during juxtarenal aneurysm repair.

Question 218

Question 228 of 328 Which of the following is not a branch of the posterior cord of the brachial plexus? A. Thoracodorsal nerve B. Axillary nerve C. Radial nerve D. Lower subscapular nerve E. Musculocutaneous nerve

Answer 218

Musculocutaneous nerveMnemonic branches off the posterior cordS ubscapular (upper and lower)T horacodorsalA xillaryR adialThe musculocutaneous nerve is a branch off the lateral cord.

Question 219

Question 229 of 328 A 18 year old man presents with an indirect inguinal hernia and undergoes surgery. The deep inguinal ring is exposed and held with a retractor at its medial aspect. Which structure is most likely to lie under the retractor? A. Ureter B. Inferior epigastric artery C. Internal iliac vein D. Femoral artery E. Lateral border of rectus abdominis

Answer 219

Inferior epigastric arteryBoundaries of the deep inguinal ring: Superolaterally - transversalis fascia Inferomedially - inferior epigastric arteryThe deep inguinal ring is closely related to the inferior epigastric artery. The inferior epigastric artery forms part of the structure referred to as Hesselbach’s triangle.

Question 220

Question 230 of 328 A 73 year old man presents with a tumour at the tip of his tongue. To which of the following regions will the tumour initially metastasise? A. Sub mental nodes B. Ipsilateral deep cervical nodes C. Tonsil D. Ipsilateral superficial cervical nodes E. Contralateral deep cervical nodes

Answer 220

Sub mental nodes

Question 221

Question 231 of 328 A 78 year old man is undergoing a femoro-popliteal bypass graft. The operation is not progressing well and the surgeon is complaining of poor access. Retraction of which of the following structures will improve access to the femoral artery in the groin? A. Quadriceps B. Adductor longus C. Adductor magnus D. Pectineus E. Sartorius

Answer 221

SartoriusAt the lower border of the femoral triangle the femoral artery passes under the sartorius muscle. This can be retracted to improve access.

Question 222

Question 232 of 328 A builder falls off a ladder whilst laying roof tiles. He sustains a burst fracture of L3. The MRI scan shows complete cord transection at this level as a result of the injury. Which clinical sign will not be present initially? A. Flaccid paralysis of the legs B. Extensor plantar response C. Sensory loss in the legs D. Incontinence E. Areflexia

Answer 222

Extensor plantar responseIn lower motor neuron lesions everything is reducedThe main purpose of this question is to differentiate the features of an UMN lesion and a LMN lesion. The features of a LMN lesion include: Flaccid paralysis of muscles supplied Atrophy of muscles supplied. Loss of reflexes of muscles supplied. Muscles fasciculation For lesions below L1 LMN signs will occur. Hence in an L3 lesion, there will be loss of the patella reflex but there will be no extensor plantar reflex.

Question 223

Question 233 of 328 A 56 year old machinist has his arm entrapped in a steel grinder and is brought to the emergency department. On examination, he is unable to extend his metacarpophalangeal joints and abduct his shoulder. He has weakness of his elbow and wrist. What has been injured? A. Ulnar nerve B. Axillary nerve C. Medial cord of brachial plexus D. Lateral cord of brachial plexus E. Posterior cord of brachial plexus

Answer 223

Posterior cord of brachial plexusThe posterior cord gives rise to: Radial nerve ((innervates the triceps, brachioradialis, wrist extensors, and finger extensors) Axillary nerve (innervates deltoid and teres minor) Upper subscapular nerve (innervates subscapularis) Lower subscapular nerve (innervates teres major and subscapularis) Thoracodorsal nerve (innervates latissimus dorsi) Theme from September 2012 examThis is a description of a posterior cord lesion. Remember that the posterior cord gives rise to the axillary and radial nerve.

Question 224

Question 234 of 328 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? A. Lateral compartment B. Anterior compartment C. Superficial posterior compartment D. Deep posterior compartment E. None of the above

Answer 224

Lateral CompartmentThe 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.

Question 225

Question 235 of 328 A 70 year old man is due to undergo an arterial bypass procedure for claudication and foot ulceration. The anterior tibial artery will form the site of the distal arterial anastomosis. Which of the following structures is not closely related to it? A. Interosseous membrane B. Deep peroneal nerve C. Tibialis posterior D. Extensor hallucis longus E. Dorsalis pedis artery

Answer 225

Tibialis posteriorAs an artery of the anterior compartment, the anterior tibial artery is closely related to tibialis anterior.

Question 226

Question 236 of 328 Which of the muscles below does not cause lateral rotation of the hip? A. Obturator internus B. Quadratus femoris C. Gemellus inferior D. Piriformis E. Pectineus

Answer 226

PectineusMnemonic lateral hip rotators: P-GO-GO-Q (top to bottom)PiriformisGemellus superiorObturator internusGemellus inferiorObturator externusQuadratus femorisPectineus adducts and medially rotates the femur.

Question 227

Question 237 of 328 Which of the following is not a content of the posterior triangle of the neck? A. Spinal accessory nerve B. Phrenic nerve C. External jugular vein D. Occipital lymph nodes E. Internal jugular vein

Answer 227

The IJV does not lie in the posterior triangle. However, the terminal branches of the external jugular vein do.

Question 228

Question 238 of 328 Which nerve is at risk during submandibular gland excision? A. Maxillary nerve B. Buccal nerve C. Zygomatic nerve D. Marginal mandibular nerve E. Cervical nerve

Answer 228

Marginal mandibular nerveThe marginal mandibular nerve lies deep to platysma. It supplies the depressor anguli oris and the depressor labii inferioris. If injured it may lead to facial asymmetry and dribbling.

Question 229

Question 239 of 328 In a patient with a carcinoma of the distal sigmoid colon, what is the most likely source of its blood supply? A. Ileocolic artery B. External iliac artery C. Internal iliac artery D. Superior mesenteric artery E. Inferior mesenteric artery

Answer 229

Inferior mesenteric arteryTheme from September 2013 ExamDuring a high anterior resection of such tumours, the inferior mesenteric artery is ligated. Note that the branches (mainly middle rectal branch) of the internal iliac artery are important in maintaining vascularity of the rectal stump and hence the integrity of the anastomoses.

Question 230

Question 240 of 328 Which of these openings transmits the facial nerve into the temporal bone? A. Internal acoustic meatus B. Foramen lacerum C. Foramen spinosum D. Stylomastoid foramen E. Jugular foramen

Answer 230

Internal acoustic meatust enters the temporal bone through the internal acoustic meatus and exits through the stylomastoid foramen.

Question 231

Question 241 of 328 A motor cyclist is involved in a road traffic accident causing severe right shoulder injuries. He is found to have an adducted, medially rotated shoulder. The elbow is fully extended and the forearm pronated. Which is the most likely diagnosis? A. C8, T1 root lesion B. C5, C6 root lesion C. Radial nerve lesion D. Ulnar nerve lesion E. Axillary nerve lesion

Answer 231

. C5, C6 root lesionErbs Palsy C5, C6 lesionThe features include: Waiter’s tip position Loss of shoulder abduction (deltoid and supraspinatus paralysis) Loss of external rotation of the shoulder (paralysis of infraspinatus and teres major) Loss of elbow flexion (paralysis of biceps, brachialis and brachioradialis) Loss of forearm supination (paralysis of Biceps)The motorcyclist has had an Erb’s palsy (C5, C6 root lesion). This is commonly known to be associated with birth injury when a baby has a shoulder dystocia.

Question 232

Question 242 of 328 A patient is due to undergo a right hemicolectomy for a carcinoma of the caecum. Which of the following vessels will require high ligation to provide optimal oncological control? A. Middle colic artery B. Inferior mesenteric artery C. Superior mesenteric artery D. Ileo-colic artery E. None of the above

Answer 232

Ileo-colic arteryThe ileo - colic artery supplies the caecum and would require high ligation during a right hemicolectomy. The middle colic artery should generally be preserved when resecting a caecal lesion.This question is essentially asking you to name the vessel supplying the caecum. The SMA does not directly supply the caecum, it is the ileocolic artery which does this

Question 233

Question 243 of 328 A 40-year-old man presents with pain in his lower back and ‘sciatica’ for the past three days. He describes bending down to pick up a washing machine when he felt ‘something go’. He now has severe pain radiating from his back down the right leg. On examination he describes paraesthesia over the anterior aspect of the right knee and the medial aspect of his calf. Power is intact and the right knee reflex is diminished. The femoral stretch test is positive on the right side. Which nerve or nerve root is most likely to be affected? A. Common peroneal nerve B. Lateral cutaneous nerve of the thigh C. L5 D. L3 E. L4

Answer 233

L3

Question 234

Question 244 of 328 A 72 year old man is undergoing a repair of an abdominal aortic aneurysm. The aorta is cross clamped both proximally and distally. The proximal clamp is applied immediately inferior to the renal arteries. Both common iliac arteries are clamped distally. A longitudinal aortotomy is performed. After evacuating the contents of the aneurysm sac a significant amount of ongoing bleeding is encountered. This is most likely to originate from: A. The coeliac axis B. Testicular artery C. Splenic artery D. Superior mesenteric artery E. Lumbar arteries

Answer 234

The lumbar arteries are posteriorly sited and are a common cause of back bleeding during aortic surgery. The other vessels cited all exit the aorta in the regions that have been cross clamped.

Question 235

Question 245 of 328 Which of the following statements relating to sartorius is untrue? A. It is supplied by the femoral nerve B. It forms the lateral boundary of the femoral triangle C. The middle third forms the roof of the adductor canal D. It is a flexor of the hip and knee E. It inserts into the medial femoral condyle

Answer 235

It inserts into the medial femoral condyleIt inserts into the medial aspect of the upper part of the tibia.

Question 236

Question 246 of 328 A 63 year old man undergoes a radical cystectomy for carcinoma of the bladder. During the procedure there is considerable venous bleeding. What is the primary site of venous drainage of the urinary bladder? A. Vesicoprostatic venous plexus B. Internal iliac vein C. External iliac vein D. Gonadal vein E. Common iliac vein

Answer 236

Vesicoprostatic venous plexusThe urinary bladder has a rich venous plexus surrounding it, this drains subsequently into the internal iliac vein. The vesicoprostatic plexus may be a site of considerable venous bleeding during cystectomy.

Question 237

Question 247 of 328 A 60 year old female is undergoing a Whipples procedure for adenocarcinoma of the pancreas. As the surgeons begin to mobilise the pancreatic head they identify a large vessel passing inferiorly over the anterior aspect of the uncinate process. What is it likely to be? A. Superior mesenteric artery B. Coeliac axis C. Inferior mesenteric artery D. Aorta E. Left gastric artery

Answer 237

Theme from January 2012 ExamThe superior mesenteric artery arises from the aorta and passes anterior to the lower part of the pancreas. Invasion of this structure is a relative contra indication to resectional surgery.

Question 238

Question 248 of 328 A 23 year old man has a cannula inserted into his cephalic vein. Through which structure does the cephalic vein pass? A. Interosseous membrane B. Triceps C. Pectoralis major D. Clavipectoral fascia E. Tendon of biceps

Answer 238

Clavipectoral fasciaThe cephalic vein is a favored vessel for arteriovenous fistula formation and should be preserved in patients with end stage renal failureThe cephalic vein penetrates the calvipectoral fascia (but not the pectoralis major) prior to terminating in the axillary vein.

Question 239

Question 249 of 328 An 18 year old man is undergoing an orchidectomy via a scrotal approach. The surgeons mobilise the spermatic cord. From which of the following is the outermost layer of this structure derived? A. Internal oblique aponeurosis B. External oblique aponeurosis C. Transversalis fascia D. Rectus sheath E. Campers fascia

Answer 239

External oblique aponeurosisThe outermost covering of the spermatic cord is derived from the external oblique aponeurosis.This layer is added as the cord passes through the superficial inguinal ring.

Question 240

Question 250 of 328 Which of the following is not a carpal bone? A. Trapezium B. Triquetrum C. Trapezoid D. Trapezius E. Lunate

Answer 240

TrapeziusMnemonic for the Carpal BonesSally Likes To Play The Tiny Chrome HarmonicaShe Looks Too Pretty Try To Catch HerScared Lovers Try Positions That They Can’t Handle

Question 241

Question 251 of 328 A 53 year old male presents with a carcinoma of the transverse colon. Which of the following structures should be ligated close to their origin to maximise clearance of the tumour? A. Superior mesenteric artery B. Inferior mesenteric artery C. Middle colic artery D. Ileo-colic artery E. Superior rectal artery

Answer 241

The middle colic artery supplies the transverse colon and requires high ligation during cancer resections. It is a branch of the superior mesenteric artery.

Question 242

Question 252 of 328 Which of the following structures are not closely related to the adductor longus muscle? A. Long saphenous vein B. Tendon of iliacus C. The profunda branch of the femoral artery D. Pectineus muscle E. Femoral nerve

Answer 242

B. Tendon of iliacus Femoral triangle:Adductor longus mediallyInguinal ligament superiorlySartorius muscle laterallyAdductor 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.

Question 243

Question 253 of 328 Which of the following structures does not lie posterior to the right kidney? A. Psoas major B. 12th rib C. Quadratus lumborum D. Medial artcuate ligament E. 10th rib

Answer 243

10th ribTheme from April 2012 ExamThe 8th and10th ribs lie more superiorly. The 12th rib is a closer relation posteriorly.Quadratus lumborum runs between the posterior part of the iliac crest, iliolumbar ligament and the transverse processes of the lower lumbar vertebrae to the medial part of the lower border of the last rib and transverse process of the upper lumbar vertebrae. In these last two locations it is posterior to the kidney.

Question 244

Question 254 of 328 A 56 year old man is undergoing a radical nephrectomy via a posterior approach. Which of the following structures is most likely to be encountered during the operative approach? A. 8th rib B. 10th rib C. 6th rib D. 12th rib E. 9th rib

Answer 244

12th ribThe 11th and 12th ribs lie posterior to the kidneys and may be encountered during a posterior approach. A pneumothorax is a recognised complication of this type of surgery.

Question 245

Question 255 of 328 A 73 year old lady presents with a femoral hernia. Which of the following structures forms the lateral wall of the femoral canal? A. Pubic tubercle B. Femoral vein C. Femoral artery D. Conjoint tendon E. Femoral nerve

Answer 245

Femoral veinThe canal exists to allow for the physiological expansion of the femoral vein, which lies lateral to it.

Question 246

Question 256 of 328 Which of the following is not a muscle of the rotator cuff? A. Subscapularis B. Teres minor C. Supraspinatus D. Infraspinatus E. Deltoid

Answer 246

Deltoid may abduct the shoulder and is not a rotator cuff muscle.

Question 247

Question 257 of 328 Which of the following muscles is not within the posterior compartment of the lower leg? A. Peroneus brevis B. Flexor digitorum longus C. Soleus D. Popliteus E. Flexor hallucis longus

Answer 247

Peroneus brevisTheme from 2007 ExamPeroneus brevis lies in the lateral compartment.

Question 248

Question 258 of 328 How many unpaired branches leave the abdominal aorta to supply the abdominal viscera? A. One B. Two C. Three D. Four E. Five

Answer 248

3There 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.

Question 249

Question 259 of 328 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. A. Facial artery B. Facial vein C. Lingual nerve D. Hypoglossal nerve E. Glossopharyngeal nerve

Answer 249

Facial veinWhen 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 mylohoid muscle. The facial artery grooves the deep aspect of 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).

Question 250

Question 260 of 328 You are working as an anatomy demonstrator and the medical students decide to test your knowledge on the circle of willis. Which of the following comments is false? A. Does not include the middle cerebral artery B. Asymmetry of the circle of willis is a risk factor for the development of intracranial aneurysms C. Majority of blood passing through the vessels mix together D. Includes the anterior communicating arteries E. The circle surrounds the stalk of the pituitary gland

Answer 250

Majority of blood passing through the vessels mix togetherThere is minimum mixing of blood passing through the vessels.

Question 251

Question 261-263 of 328 Theme: Surgical nerve lesionsA. Recurrent laryngeal nerveB. Accessory nerveC. Hypoglossal nerveD. Vagus nerveE. Common peroneal nerveF. Tibial nerveG. Long saphenous nerveH. Phrenic nerveI. Thoracodorsal nervePlease choose which of the listed nerves is at greatest risk for the procedures given. Each option may be used once, more than once or not at all.261. A 64 year old man has a suspected lymphoma and lymph node biopsy from the posterolateral aspect of the right neck is planned.262. A 43 year old women is due to undergo an axillary node clearance following a positive sentinel node biopsy.263. A 53 year old man is to undergo an abdomino-perineal excision of the colon and rectum for a tumour 2cm from the anal verge.

Answer 251

Question 261-263 of 328 Theme: Surgical nerve lesionsA. Recurrent laryngeal nerveB. Accessory nerveC. Hypoglossal nerveD. Vagus nerveE. Common peroneal nerveF. Tibial nerveG. Long saphenous nerveH. Phrenic nerveI. Thoracodorsal nervePlease choose which of the listed nerves is at greatest risk for the procedures given. Each option may be used once, more than once or not at all.261. A 64 year old man has a suspected lymphoma and lymph node biopsy from the posterolateral aspect of the right neck is planned.Accessory nerveThe accessory nerve has a superficial course and is easily injured. It lies under platysma and may be divided during the early part of the procedure.262. A 43 year old women is due to undergo an axillary node clearance following a positive sentinel node biopsy.You answered Common peroneal nerveThe correct answer is Thoracodorsal nerveThe long thoracic nerve is also at risk. This nerve traverses the level 2 axillary nerves to supply latissimus dorsi and may be divided or damaged with diathermy.263. A 53 year old man is to undergo an abdomino-perineal excision of the colon and rectum for a tumour 2cm from the anal verge.You answered Phrenic nerveThe correct answer is Common peroneal nerveThis operation is commonly performed in the Lloyd Davies position and if the patient is not positioned correctly a nerve lesion may occur as a result of pressure neuropraxia.

Question 252

Question 264 of 328 A 45 year old man presents with bilateral inguinal hernias. The surgical team decide to repair these laparoscopically through an extraperitoneal approach. Through an infraumbilical incision the surgeons displace the inferior aspect of the rectus abdominis muscle anteriorly and place a prosthetic mesh into the area to repair the hernias. Which structure will lie posterior to the mesh? A. Peritoneum B. Internal oblique aponeurosis C. External oblique aponeurosis D. Posterior aspect of the rectus sheath E. Bucks fascia

Answer 252

PeritoneumDuring a TEP repair of inguinal hernia the only structure to lie posterior to the mesh is peritoneum. The question is really only asking which structure lies posterior to the rectus abdominis muscle. Since this region is below the arcuate line the transversalis fascia and peritoneum lie posterior to it. Bucks fascia lies in the penis.

Question 253

Question 265 of 328 A 20 year old man undergoes an open appendicectomy performed via a lanz incision. This surgeon places the incision on a level of the anterior superior iliac spine in an attempt to improve cosmesis. During the procedure the appendix is found to be retrocaecal and the incision is extended laterally. Which of the following nerves is at greatest risk of injury? A. Genitofemoral B. Ilioinguinal C. Obturator D. Lateral femoral cutaneous E. Femoral

Answer 253

Ilioinguinal

Question 254

Question 266 of 328 The femoral nerve is transected by a rather careless surgeon during a botched femoro-popliteal bypass operation. Which of the following actions will be impaired? A. Extension of the great toe B. Adduction of the thigh C. Flexion of the knee joint D. Extension of the knee joint E. Eversion of the foot

Answer 254

The femoral nerve supplies the quadriceps muscle which is responsible for extension at the knee joint.

Question 255

Question 267 of 328 Which of the following is not a direct branch of the facial nerve? A. Greater petrosal nerve B. Nerve to stapedius C. Auriculotemporal D. Chorda tympani E. Buccal

Answer 255

AuriculotemporalThe auriculotemporal nerve is a direct branch of the mandibular nerve.Other branches of the mandibular nerve include:LingualInferior AlveolarN. To the MylohyoidMental

Question 256

Question 268 of 328 A 32 year old man is stabbed in the neck and the inferior trunk of his brachial plexus is injured. Which of the modalities listed below is least likely to be affected? A. Initiating abduction of the shoulder B. Abduction of the fingers C. Flexion of the little finger D. Sensation on the palmar aspect of the little finger E. Gripping a screwdriver

Answer 256

Initiating abduction of the shoulderInferior trunk of brachial plexus. C8 and T1 roots Contributes to ulnar nerve and part of median nerveTheme from September 2012 ExamThe inferior trunk of the brachial plexus is rarely injured. Nerve roots C8 and T1 are the main contributors to this trunk. Therefore an injury to this site will most consistently affect the ulnar nerve. The inferior trunk also contributes to the median nerve by way of the posterior division and therefore some impairment of grip is almost inevitable.

Question 257

Question 269 of 328 During embryological development, which of the following represent the correct origin of the pancreas? A. Ventral and dorsal endodermal outgrowths of the duodenum B. Ventral and dorsal outgrowths of mesenchymal tissue from the posterior abdominal wall C. Ventral and dorsal outgrowths of the vitellointestinal duct D. Ventral and dorsal biliary tract diverticulae E. Buds from the inferior aspect of the caudate lobe

Answer 257

A. Ventral and dorsal endodermal outgrowths of the duodenumThe pancreas develops from a ventral and dorsal endodermal outgrowth of the duodenum. The ventral arises close to, or in common with the hepatic diverticulum, and the larger, dorsal outgrowth arises slightly cranial to the ventral extending into the mesoduodenum and mesogastrium. When the buds eventually fuse the duct of the ventral rudiment becomes the main pancreatic duct.

Question 258

Question 270 of 328 Which of the following is not a content of the anterior triangle of the neck? A. Ansa cervicalis B. Vagus nerve C. Anterior jugular vein D. Transverse cervical nerve E. Hypoglossal nerve

Answer 258

Transverse cervical nerve

Question 259

Question 271 of 328 A 23 year old man presents with delayed diagnosis of appendicitis. The appendix is retrocaecal and has perforated causing a psoas abscess. Into which structure does the psoas major muscle insert? A. Greater trochanter of the femur B. Linea aspera of the femur C. Lesser trochanter of the femur D. Iliac crest E. None of the above

Answer 259

Theme based on 2011 examThe psoas major inserts into the lesser trochanter.

Question 260

Question 272 of 328 A 63 year old man is due to undergo a splenectomy. Which splenic structure lies most posteriorly? A. Gastrosplenic ligament B. Splenic vein C. Splenic artery D. Splenic notch E. Lienorenal ligament

Answer 260

Lienorenal ligamentTheme from 2011 ExamThe lienorenal ligament lies most posteriorly. The antero-lateral connection is via the phrenicocolic ligament. Anteriorly the gastro splenic ligament. These structures condense around the vessels at the splenic hilum.

Question 261

Question 273 of 328 Which of these statements relating to the external carotid is false? A. It ends by bifurcating into the superficial temporal and ascending pharyngeal artery B. Its first branch is the superior thyroid artery C. The superior thyroid, lingual and facial arteries all arise from its anterior surface D. The ascending pharyngeal artery is a medial branch E. Initially it lies anteromedial to the internal carotid

Answer 261

It ends by bifurcating into the superficial temporal and ascending pharyngeal arteryIt terminates by dividing into the superficial temporal and maxillary branches. The external carotid has eight branches, 3 from its anterior surface ; thyroid, lingual and facial. The pharyngeal artery is a medial branch. The posterior auricular and occipital are posterior branches.

Question 262

Question 274 of 328 Which of the following statements about the spleen is false? A. The hilum contains the splenic vessels. B. The spleen is derived from endodermal tissue. C. The white pulp has immune function. D. The colon lies inferiorly. E. Weighs 150g.

Answer 262

The spleen is derived from endodermal tissue.1,3,5,7,9,11 (odd numbers up to 11)The spleen is: 1 inch thick, 3 inches wide, 5 inches long, weighs 7oz (150-200g), lies between the 9th and 11th ribsMost of the gut is derived endodermally except for the spleen which is from mesenchymal tissue.

Question 263

Question 275 of 328 As it exits the axilla the radial nerve lies on which of the following muscles? A. Supraspinatus B. Infraspinatus C. Teres major D. Deltoid E. Pectoralis major

Answer 263

Teres majorThe radial nerve passes through the triangular space to leave the axilla. The superior border of this is bounded by the teres major muscle to which the radial nerve is closely related.

Question 264

Question 276 of 328 Into which of the following veins does the middle thyroid vein drain? A. Vertebral B. External jugular C. Internal jugular D. Subclavian E. Anterior jugular

Answer 264

It drains to the internal jugular vein. Which is one of the reasons why it bleeds so copiously if a ligature slips.

Question 265

Question 277 of 328 Which of the following structures is not at the level of the transpyloric plane? A. Hilum left kidney B. Superior mesenteric artery C. Fundus of the gallbladder D. Cardioesophageal junction E. Root of transverse mesocolon

Answer 265

Cardiooesophageal junction level = T11A knowledge of this anatomic level is commonly tested.The oesophagus extends from C6 (the lower border of the cricoid cartilage) to T11 at the cardioesophageal junction. Note that in the neonate the oesophagus extends from C4 or C5 to T9.

Question 266

Question 278 of 328 A 62 year old man presents with arm weakness. On examination he has a weakness of elbow extension and loss of sensation on the dorsal aspect of the first digit. What is the site of the most likely underlying defect? A. Axillary nerve B. Median nerve C. Ulnar nerve D. Radial nerve E. Musculocutaneous nerve

Answer 266

Radial nerveTheme from April 2012 ExamThe long head of the triceps muscle may be innervated by the axillary nerve and therefore complete loss of triceps muscles function may not be present even with proximally sited nerve lesions.

Question 267

Question 279 of 328 From which of the following structures does the long head of the triceps muscle arise? A. Coracoid process B. Acromion C. Infraglenoid tubercle D. Coraco-acromial ligament E. Coraco-humeral ligament

Answer 267

Infraglenoid tubercleThe long head arises from the infraglenoid tubercle. The fleshy lateral and medial heads are attached to the posterior aspect of the humerus between the insertion of the teres minor and the olecranon fossa.

Question 268

Question 280 of 328 A 45 year old man is undergoing a left hemicolectomy. As the surgeons mobilise the left colon they identify a tubular structure lying at the inferior aspect of psoas major. What is it most likely to be? A. Left ureter B. Left common iliac vein C. Left common iliac artery D. Left external iliac artery E. Left external iliac vein

Answer 268

Left ureterThe left ureter lies posterior to the left colon. The sigmoid colon and upper rectum may be more closely related to the iliac vessels. These are not typically found above L4.

Question 269

Question 281 of 328 Which muscle is not innervated by the trigeminal nerve? A. Medial pterygoid B. Mylohyoid C. Stylohyoid D. Masseter E. Temporalis

Answer 269

Stylohyoid is innervated by the facial nerve.

Question 270

Question 282 of 328 A 42 year old woman is due to undergo a left nephroureterectomy for a transitional cell carcinoma involving the ureter. Which of the following structures is not related to the left ureter? A. Round ligament of the uterus B. Internal iliac artery C. Ovarian artery D. Peritoneum E. Sigmoid mesocolon

Answer 270

Round ligament of the uterusThe ureter is not related to the round ligament of the uterus, it is related to the broad ligament and is within 1.5cm of the supravaginal part of the cervix.

Question 271

Question 283 of 328 Which of the following most commonly arises from the brachiocephalic artery? A. Vertebral artery B. Subscapular artery C. Thyroidea ima artery D. Left Subclavian artery E. None of the above

Answer 271

Other occasional branches include the thymic and bronchial branch.

Question 272

Question 284 of 328 A 28 year old man is undergoing an appendicectomy. The external oblique aponeurosis is incised and the underlying muscle split in the line of its fibres. At the medial edge of the wound is a tough fibrous structure. Entry to this structure will most likely encounter which of the following? A. Internal oblique B. Rectus abdominis C. Transversus abdominis D. Linea alba E. Peritoneum

Answer 272

Rectus abdominisThis structure will be the rectus sheath and when entered the rectus abdominis muscle will be encountered.

Question 273

Question 285 of 328 A 35 year old man presents to the surgical clinic with a suspected direct inguinal hernia. These will pass through Hesselbach’s triangle. Which of the following forms the medial edge of this structure? A. External oblique aponeurosis B. Inferior epigastric artery C. Rectus abdominis muscle D. Inferior epigastric vein E. Obturator nerve

Answer 273

Rectus abdominis muscleDirect inguinal hernias pass through Hesselbachs triangle (although this is of minimal clinical significance!). Its medial boundary is the rectus muscle.

Question 274

Question 286 of 328 Which of the following muscles is not innervated by the ansa cervicalis? A. Sternohyoid B. Mylohyoid C. Omohyoid D. Sternothyroid E. None of the above

Answer 274

MylohoidAnsa cervicalis muscles:GHost THought SOmeone Stupid Shot IreneGenioHyoidThyroidHyoidSuperior OmohyoidSternoThyroidSternoHyoidInferior OmohyoidMylohyoid is innervated by the mylohyoid branch of the inferior alveolar nerve

Question 275

Question 287 of 328 A 58 year old lady presents with a mass in the upper outer quadrant of the right breast. Which of the following statements relating to the breast is untrue? A. The internal mammary artery provides the majority of its arterial supply B. Nipple retraction may occur as a result of tumour infiltration of the clavipectoral fascia C. The internal mammary artery is a branch of the subclavian artery D. Up to 70% of lymphatic drainage is to the ipsilateral axillary nodes E. None of the above

Answer 275

Nipple retraction may occur as a result of tumour infiltration of the clavipectoral fasciaNipple retraction is a feature of breast malignancy. However, it is typically caused by tumour infiltration of Coopers Ligaments that run through the breast and surround the lobules. The clavipectoral fascia encases the axillary contents. The lymphatic drainage of the breast is to the axilla and also to the internal mammary chain. The breast is well vascularised and the internal mammary artery is a branch of the subclavian artery.

Question 276

Question 288 of 328 Where are accessory spleens not found? A. Gonads B. Tail of pancreas C. Greater omentum D. Splenorenal ligament E. Ureter

Answer 276

UreterAccessory spleens- 10% population- 1 cm size- locations: hilum of the spleen, tail of the pancreas, along the splenic vessels, in the gastrosplenic ligament, the splenorenal ligament, the walls of the stomach or intestines, the greater omentum, the mesentery, the gonads

Question 277

Question 289-291 of 328 Theme: Nerve injuryA. Median nerveB. Ulnar nerveC. Radial nerveD. Anterior interosseous nerveE. Posterior interosseous nerveF. Axillary nerveG. Musculocutaneous nervePlease select the nerve at risk of injury in each scenario. Each option may be used once, more than once or not at all.289. A 43 year old typist presents with pain at the dorsal aspect of the upper part of her forearm. She also complains of weakness when extending her fingers. On examination triceps and supinator are both functioning normally. There is weakness of most of the extensor muscles. However, there is no sensory deficit.290. A 28 year teacher reports difficulty with writing. There is no sensory loss. She is known to have an aberrant Gantzer muscle.291. A 35 year tennis player attends reporting tingling down his arm. He says that his ‘funny bone’ was hit very hard by a tennis ball. There is weakness of abduction and adduction of his extended fingers.

Answer 277

Question 289-291 of 328 Theme: Nerve injuryA. Median nerveB. Ulnar nerveC. Radial nerveD. Anterior interosseous nerveE. Posterior interosseous nerveF. Axillary nerveG. Musculocutaneous nervePlease select the nerve at risk of injury in each scenario. Each option may be used once, more than once or not at all.289. A 43 year old typist presents with pain at the dorsal aspect of the upper part of her forearm. She also complains of weakness when extending her fingers. On examination triceps and supinator are both functioning normally. There is weakness of most of the extensor muscles. However, there is no sensory deficit.You answered Ulnar nerveThe correct answer is Posterior interosseous nerveThe radial nerve may become entrapped in the “arcade of Frohse” which is a superficial part of the supinator muscle which overlies the posterior interosseous nerve. This nerve is entirely muscular and articular in its distribution. It passes postero-inferiorly and gives branches to extensor carpi radialis brevis and supinator. It enters supinator and curves around the lateral and posterior surfaces of the radius. On emerging from the supinator the posterior interosseous nerve lies between the superficial extensor muscles and the lowermost fibres of supinator. It then gives branches to the extensors.290. A 28 year teacher reports difficulty with writing. There is no sensory loss. She is known to have an aberrant Gantzer muscle.You answered Posterior interosseous nerveThe correct answer is Anterior interosseous nerveAnterior interosseous lesions occur due to fracture, or rarely due to compression. The Gantzer muscle is an aberrant accessory of the flexor pollicis longus and is a risk factor for anterior interosseous nerve compression. Remember loss of pincer grip and normal sensation indicates an interosseous nerve lesion.291. A 35 year tennis player attends reporting tingling down his arm. He says that his ‘funny bone’ was hit very hard by a tennis ball. There is weakness of abduction and adduction of his extended fingers.You answered Radial nerveThe correct answer is Ulnar nerveTheme from September 2012 examThe ulnar nerve arises from the medial cord of the brachial plexus (C8, T1 and contribution from C7). The nerve descends between the axillary artery and vein, posterior to the cutaneous nerve of the forearm and then lies anterior to triceps on the medial side of the brachial artery. In the distal half of the arm it passes through the medial intermuscular septum, and continues between this structure and the medial head of triceps to enter the forearm between the medial epicondyle of the humerus and the olecranon. It may be injured at this site in this scenario.

Question 278

Question 292 of 328 A 72 year old man is undergoing a left pneumonectomy for carcinoma of the bronchus. As the surgeons approach the root of the lung, which structure will lie most anteriorly (in the anatomical plane)? A. Vagus nerve B. Phrenic nerve C. Bronchus D. Pulmonary vein E. Pulmonary artery

Answer 278

Phrenic nerveThe phrenic nerve is the most anteriorly located structure in the lung root. The vagus nerve lies most posteriorly.

Question 279

Question 293 of 328 A 56 year old man is undergoing an anterior resection for a carcinoma of the rectum. Which of the structures below is least likely to be encountered during the mobilisation of the anterior rectum? A. Denonvilliers’ fascia B. Middle sacral artery C. Bladder D. Rectovesical pouch E. Seminal vesicles

Answer 279

Middle sacral arteryWith the exception of the middle sacral artery all of the other structures lie anterior to the rectum. They may all be palpated during digital rectal examination.

Question 280

Question 294 of 328 In relation to the middle cranial fossa, which of the following statements relating to the foramina are incorrect? A. The foramen rotundum transmits the maxillary nerve B. The foramen lacerum transmits the internal carotid artery C. The foramen spinosum lies posterolateral to the foramen ovale D. The foramen ovale transmits the middle meningeal artery E. The foramen rotundum lies anteromedial to the foramen ovale

Answer 280

Theme addressed in 2010 and 2011 examThe foramen spinosum transmits the middle meningeal artery. The foramen ovale transmits the mandibular nerve. As the foramina weaken the bone a fracture at this site is not uncommon.

Question 281

Question 295 of 328 During an operation for varicose veins the surgeons are mobilising the long saphenous vein. Near its point of entry to the femoral vein an artery is injured and bleeding is encountered. From where is the bleeding most likely to originate? A. Femoral artery B. Profunda femoris artery C. Superficial circumflex iliac artery D. Superficial epigastric artery E. Deep external pudendal artery

Answer 281

Deep external pudendal arteryTheme from 2011 ExamThe deep external pudendal artery is a branch of the SFA and it runs medially under the long saphenous vein near its point of union with the femoral vein. The superficial external pudendal artery lies superior to the SFJ. Neither vessel is functionally important and if injured they are best ligated.

Question 282

Question 296 of 328 What is embryological origin of the pulmonary artery? A. First pharyngeal arch B. Second pharyngeal arch C. Fourth pharyngeal arch D. Fifth pharyngeal arch E. Sixth pharyngeal arch

Answer 282

Sixth pharyngeal archTheme from September 2011 ExamTheme from September 2012 ExamThe proximal part of the sixth right pharyngeal arch gives origin to the right pulmonary artery. The distal part gives origin to the left pulmonary artery and the ductus arteriosus.

Question 283

Question 297 of 328 A 53 year old lady presents with pain and discomfort in her hand. She works as a typist and notices that the pain is worst when she is working. She also suffers symptoms at night. Her little finger is less affected by the pain. Which of the nerves listed below is most likely to be affected? A. Radial B. Median C. Ulnar D. Anterior interosseous nerve E. Posterior interosseous nerve

Answer 283

MedianMotor supply: LOAFL ateral 2 lumbricalsO pponens pollicisA bductor pollicisbrevisF lexor pollicis brevisTheme from April 2012 ExamThe most likely diagnosis here is carpal tunnel syndrome, the median nerve is compressed in the wrist and symptoms usually affect the fingers and wrist either at night or when the hand is being used (e.g. as a typist).

Question 284

Question 298 of 328 Which of the following muscles lies medial to the long thoracic nerve? A. Serratus anterior B. Latissimus dorsi C. Pectoralis major D. Pectoralis minor E. None of the above

Answer 284

Serratus anterior

Question 285

Question 299 of 328 The thesbian veins contribute to the venous drainage of the heart. Into which of the following structures do they primarily drain? A. Great cardiac vein B. Atrium C. Superior vena cava D. Oblique vein E. Small cardiac vein

Answer 285

AtriumThe thesbian veins are numerous small veins running over the surface of the heart they drain into the heart itself. Usually this is to the atrium directly.

Question 286

Question 300 of 328 Which of the following is not contained within the deep posterior compartment of the lower leg? A. Tibialis posterior muscle B. Posterior tibial artery C. Tibial nerve D. Sural nerve E. Flexor hallucis longus

Answer 286

The deep posterior compartment lies anterior to soleus. The sural nerve is superficially sited and therefore not contained within it.

Question 287

Question 301 of 328 When performing minor surgery in the scalp, which of the following regions is considered a danger area as regards spread of infection into the CNS? A. Aponeurosis epicranialis B. Skin C. Pericranium D. Connective tissue E. Loose areolar tissue

Answer 287

Loose areolar tissueThis area is most dangerous as infections can spread easily. The emissary veins that drain this area may allow sepsis to spread to the cranial cavity.

Question 288

Question 302 of 328 Which of the following structures are at risk of direct injury following a fracture dislocation of the femoral condyles? A. Popliteal artery B. Sciatic nerve C. Plantaris muscle D. Tibial artery E. Tibial nerve

Answer 288

Popliteal arteryThe heads of gastrocnemius will contract to pull the fracture segment posteriorly. The popliteal artery lies against the bone and may be damaged or compressed.

Question 289

Question 303 of 328 A 25 year old man is being catheterised, prior to a surgical procedure. As the catheter enters the prostatic urethra which of the following changes will occur? A. Resistance will increase significantly B. Resistance will increase slightly C. It will lie horizontally D. Resistance will decrease E. It will deviate laterally

Answer 289

Resistance will decrease Theme from September 2011 ExamThe prostatic urethra is much wider than the membranous urethra and therefore resistance will decrease. The prostatic urethra is inclined vertically.

Question 290

Question 304 of 328 A 24 year female is admitted to A&E with tingling of her hand after a fall. She is found to have a fracture of the medial epicondyle. What is the most likely nerve lesion? A. Ulnar nerve B. Radial nerve C. Median nerve D. Axillary nerve E. Cutaneous nerve

Answer 290

ulnar nerveThe radial nerve is located near the lateral epicondyle.

Question 291

Question 305 of 328 During a gangland gunfight a man is shot in the chest. The bullet passes through the posterior mediastinum (from left to right). Which of the following structures is least likely to be injured A. Thoracic duct B. Oesophagus C. Vagus nerve D. Descending thoracic aorta E. Arch of the azygos vein

Answer 291

Arch of the azygos veinThe arch of the azygos vein lies in the middle mediastinum.

Question 292

Question 306 of 328 The space between the vocal cords is referred to as which of the following? A. Piriform recess B. Rima vestibuli C. Vestibule D. Glottis E. Rima glottidis

Answer 292

Rima glottidisThe rima glottidis is the narrowest part of the laryngeal cavity.

Question 293

Question 307 of 328 A 78 year old man develops a carcinoma of the scrotum. To which of the following lymph node groups may the tumour initially metastasise? A. Para aortic B. Obturator C. Inguinal D. Meso rectal E. None of the above

Answer 293

The scrotum is drained by the inguinal nodes.

Question 294

Question 308 of 328 A 63 year old man is undergoing an upper GI endoscopy for dysphagia. At 33 cm a malignant looking stricture is encountered. The endoscopist attempts a balloon dilatation.Unfortunately the tumour splits through the oesophageal wall. Into which region will the oesophageal contents now drain? A. Superior mediastinum B. Posterior mediastinum C. Middle mediastinum D. Anterior mediastinum E. Peritoneal cavity

Answer 294

At this position the oesophagus is still likely to be intrathoracic and located in the posterior mediastinum.

Question 295

Question 309 of 328 During a tricuspid valve repair the right atrium is opened, following establishment of cardiopulmonary bypass. Which of the following structures do not lie within the right atrium? A. Crista terminalis B. Tricuspid valve C. Fossa ovalis D. Trabeculae carnae E. Musculi pectinati

Answer 295

Trabeculae carnaeStructures within the right atrium: Musculi pectinati Crista terminalis Opening of the coronary sinus Fossa ovalisThe trabeculae carnae are located in the right ventricle.

Question 296

Question 310 of 328 Which of the following is a recognised tributary of the retromandibular vein? A. Internal jugular vein B. External jugular vein C. Anterior temporal diploic vein D. Maxillary vein E. Inferior opthalmic vein

Answer 296

Maxillary veinThe retromandibular vein is formed from the union of the maxillary and superficial temporal veins.

Question 297

Question 311 of 328 An 22 year old soldier is shot in the abdomen and amongst his various injuries is a major disruption to the abdominal aorta. There is torrential haemorrhage and the surgeons decide to control the aorta by placement of a vascular clamp immediately inferior to the diaphragm. Which of the following vessels may be injured in this maneouvre? A. Inferior phrenic arteries B. Superior phrenic arteries C. Splenic artery D. Renal arteries E. Superior mesenteric artery

Answer 297

Inferior phrenic arteriesAs the first branches of the abdominal aorta the inferior phrenic arteries are at greatest risk. The superior phrenic arteries lie in the thorax. The potential space at the level of the diaphragmatic hiatus is a potentially useful site for aortic occlusion. However, leaving the clamp applied for more than about 10 -15 minutes usually leads to poor outcomes.

Question 298

Question 312 of 328 Which of the following statements relating to the gallbladder is untrue? A. The fundus is usually intra peritoneal B. Arterial supply is from the cystic artery C. The cystic artery is usually located in Calots triangle D. Calots triangle may rarely contain an aberrant hepatic artery E. Cholecystokinin causes relaxation of the gallbladder

Answer 298

Cholecystokinin causes relaxation of the gallbladderCCK causes gallbladder contraction.

Question 299

Question 313 of 328 Which of the following nerves is the primary source of innervation to the anterior scrotal skin? A. Iliohypogastric nerve B. Pudendal nerve C. Ilioinguinal nerve D. Femoral branch of the genitofemoral nerve E. Obturator nerve

Answer 299

Ilioinguinal nerveTheme from April 2012 ExamThe pudendal nerve may innervate the posterior skin of the scrotum. The anterior innervation of the scrotum is primarily provided by the ilioinguinal nerve. The genital branch of the genitofemoral nerve provides a smaller contribution.

Question 300

Question 314 of 328 The transversalis fascia contributes to which of the following? A. Pectineal ligament B. Deep inguinal ring C. Cremaster muscle and fascia D. Inguinal ligament E. External spermatic fascia

Answer 300

Deep inguinal ringThe internal spermatic fascia (derived from transversalis fascia) invests:Ducuts deferensTesticular vesselsThe principal outpouching of the transversalis fascia is the internal spermatic fascia. The mouth of the outpouching is the deep inguinal ring.

Question 301

Question 315 of 328 A 63 year old man is undergoing a right pneumonectomy for carcinoma of the bronchus. As the surgeons approach the root of the lung, which structure will lie most posteriorly (in the anatomical plane)? A. Phrenic nerve B. Main bronchus C. Vagus nerve D. Pulmonary vein E. Pulmonary artery

Answer 301

Vagus nerveThe vagus nerve is the most posteriorly located structure at the lung root. The phrenic nerve lies most anteriorly.

Question 302

Question 316 of 328 A 43 year old lady is undergoing an axillary node clearance for breast cancer. The nodal disease is bulky. During clearance of the level 3 nodes there is suddenly brisk haemorrhage. The most likely vessel responsible is: A. Thoracoacromial artery B. Cephalic vein C. Thoracodorsal trunk D. Internal mammary artery E. Posterior circumflex humeral artery

Answer 302

Thoracoacromial arteryThe thoracoacromial artery pierces the pectoralis major and gives off branches within this space. The level 3 axillary nodes lie between pectoralis major and minor.Although the thoracodorsal trunk may be injured during an axillary dissection it does not lie within the level 3 nodes.

Question 303

Question 317 of 328 A 73 year old lady with long standing atrial fibrillation develops a cold and pulseless white arm. A brachial embolus is suspected and a brachial embolectomy is performed. Which of the following structures is at greatest risk of injury during this procedure? A. Radial nerve B. Cephalic vein C. Ulnar nerve D. Median nerve E. None of the above

Answer 303

Median nerveThe median nerve lies close to the brachial artery in the antecubital fossa. This is the usual site of surgical access to the brachial artery for an embolectomy procedure. The median nerve may be damaged during clumsy application of vascular clamps to the artery.

Question 304

Question 318 of 328 A 73 year old lady is admitted with right iliac fossa pain. A plain abdominal x-ray is taken and the caecal diameter measured. Which of the following caecal diameters is pathological? A. 4cm B. 5cm C. 6cm D. 7cm E. 10cm

Answer 304

10cm8 cm is still within normal limits. However, caecal diameters of 9 and 10 are pathological and should prompt further investigation.

Question 305

Question 319 of 328 Which of the following fingers is not a point of attachment for the palmar interossei? A. Middle finger B. Little finger C. Ring finger D. Index finger E. None of the above

Answer 305

The middle finger has no attachment of the palmar interosseous.

Question 306

Question 320 of 328 A 6 year old sustains a supracondylar fracture of the distal humerus. There are concerns that the radial nerve may have been injured. What is the relationship of the radial nerve to the humerus at this point? A. Anterolateral B. Anteromedial C. Posterolateral D. Posteromedial E. Immediately anterior

Answer 306

. AnterolateralThe radial nerve lies anterolateral to the humerus in the supracondylar area.

Question 307

Question 321 of 328 Which of the following muscles is penetrated by the parotid duct? A. Medial pterygoid B. Buccinator C. Levator anguli oris D. Temporalis E. Masseter

Answer 307

BuccinatorThe duct crosses the masseter muscle and buccal fat pad and then penetrates the buccinator muscle to enter the oral cavity opposite the second upper molar tooth.

Question 308

Question 322 of 328 The following are true of the ulnar nerve except: A. It innervates the palmar interossei B. Derived from the medial cord of the brachial plexus C. Supplies the muscles of the thenar eminence D. Supplies the medial half of flexor digitorum profundus E. Passes superficial to the flexor retinaculum

Answer 308

Supplies the muscles of the thenar eminenceThese are supplied by the median nerve and atrophy of these is a feature of carpal tunnel syndrome

Question 309

Question 323 of 328 How many valves lie between the superior vena cava and the right atrium? A. None B. One C. Two D. Three E. Four

Answer 309

NoneThere are no valves which is why it is relatively easy to insert a CVP line from the internal jugular vein into the right atrium.

Question 310

Question 324 of 328 Which of the following options in relation to the liver is true? A. Ligamentum venosum is an anterior relation of the liver B. The portal triad comprises the hepatic artery, hepatic vein and tributary of the bile duct C. The liver is completely covered by peritoneum D. There are no nerves within the porta hepatis E. The caudate lobe is superior to the porta hepatis

Answer 310

The caudate lobe is superior to the porta hepatisVC 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.

Question 311

Question 325 of 328 Which of the following structures does not pass anterior to the lateral malleolus? A. Anterior tibial artery B. Extensor digitorum longus C. Tibialis anterior D. Peroneus brevis E. Peroneus tertius

Answer 311

Peroneus brevis passes posterior to the lateral malleolus.

Question 312

Question 326 of 328 The following statements regarding the rectus abdominis muscle are true except: A. It runs from the symphysis pubis to the xiphoid process B. Its nerve supply is from the ventral rami of the lower 6 thoracic nerves C. It has collateral supply from both superior and inferior epigastric vessels D. It lies in a muscular aponeurosis throughout its length E. It has a number of tendinous intersections that penetrate through the anterior layer of the muscle

Answer 312

It lies in a muscular aponeurosis throughout its lengthThe aponeurosis is deficient below the arcuate line.Rectus abdominis:Arises from 5th, 6th, 7th costal cartilages.Inserts into the pubis.The muscle lies in the rectal sheath, which also contains the superior & inferior epigastric artery and vein.Action: flexion of thoracic and lumbar spine.Nerve supply: anterior primary rami of T7-12

Question 313

Question 327 of 328 Which of the following statements relating to sternocleidomastoid is untrue? A. The external jugular vein lies posteromedially. B. It is supplied by the accessory nerve. C. It has two heads of origin D. It inserts into the lateral aspect of the mastoid process. E. It marks the anterior border of the posterior triangle.

Answer 313

The external jugular vein lies posteromedially.The external jugular vein lies lateral (i.e. superficial) to the sternocleidomastoid.

Question 314

Question 328 of 328 During liver mobilisation for a cadaveric liver transplant the hepatic ligaments will require mobilisation. Which of the following statements relating to these structures is untrue? A. Lesser omentum arises from the porta hepatis and passes the lesser curvature of the stomach B. The falciform ligament divides into the left triangular ligament and coronary ligament C. The liver has an area devoid of peritoneum D. The coronary ligament is attached to the liver E. The right triangular ligament is an early branch of the left triangular ligament

Answer 314

The right triangular ligament is an early branch of the left triangular ligamentThe right triangular ligament is a continuation of the coronary ligament.