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MRCS B Examinations and practical skills > Emrcs > Flashcards

Emrcs Flashcards

1
Q

What are the posterior cranial fossa cranial nerves?

A

7-12

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2
Q

What are the middle cranial fossa cranial nerves?

A

2-6

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3
Q

What ligaments are involved in atlanto-occipital joint?

A

Cruciate ligament: transverse and longitudinal
-Transverse ligament of atlas: arches accross ring of atlas and holds odontoid process in place

Longitudinal:
-Anterior connects transverse ligament to foramen magnum
-Posteiror connects transverse ligament ot C2

Alar ligaments
-Attach odontoid process to base of skull

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4
Q

Attachments of medial and lateral collateral ligaments

A

Lateral: lateral epicondyle of femur, fibula
Medial: medial epicondyle of femur, tibial surface and medial meniscus

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5
Q

What travels through inferior orbital fissure?

A

Maxillary nerve
Inferior ophthalmic vein
Zygomatic nerve

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6
Q

What travels through superior orbital fissure?

A

3, 4, V1 (branches), 6
Superior opthalmic vein

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7
Q

What are the orbital foramina?

A

-Optic canal
-Superior orbital fissure
-Inferior orbital fissure

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8
Q

What are the boundaries and contents of calot’s triangle?

A

Boundaries:
-Cystic duct, inferior liver, hepatic duct

Contents
-Right hepatic artery
-Cystic artery
-Lymph node of lund

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9
Q

Where does bile enter the small bowel?

A

2nd part of the duodenum, ampulla of vater

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10
Q

What ligaments/lobes are there in liver and how are they related to gallbladder/IVC?

A

Ligamentum venosum: related to caudate lobe and IVC
Quadrate lobe: related to gallbladder
Falciform ligament: anterior surface of the liver
Coronary ligament and bare area: SVC, right side
Left and right triangular ligaments: laterally on each surface
Ligamentum teres (or round ligament): free edge of falciform ligament inferiorly

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11
Q

Structures passing through both greater and lesser sciatic foramen, structures passing through leesser sciatic foramen

A

Pudendal nerve
Internal pudendal artery and vein
Nerve to obturator internus

structures passing through lesser sciatic foramen
-The above plus tendon of obturator internus

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12
Q

What receives the majority of venous drainage from the heart?

A

Coronary sinus

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13
Q

What are the tributaries of the coronary sinus?

A

-Great cardiac vein: originates at apex of heart, runs in anterior interventricular groove and curves to the left, forms coronary sinus
-Small cardiac vein: on anterior surface of heart, in groove between right atrium and right ventricle
-Middle cardiac vein (posterior interventricular)–> posterior interventricular groove
-Posterior cardiac vein: posterior surface left ventricle

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14
Q

Which cardiac veins can be seen anteriorly

A

-Great cardiac vein: originates at apex of heart, runs in interventricular groove
-Small cardiac vein: in groove between right atrium and right ventricle

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15
Q

What layers lie between the posterior aspect of the sternum and the internal surface of the left ventricle?

A

-Fibrous pericardium–> continuous with central tendon of diaphragm
-Serous pericardium
—> parietal
—> pericardial fluid
—> visceral (epicardium)

Myocardium
Endocardium

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16
Q

What are the main attachments of the fibrous pericardium?

A

-Anterior: sternum
-Superior: great vessels
-Inferior: diaphragm central tendon

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17
Q

What is the relationship of the axillary artery to the cords of the brachial plexus?

A

-First part of axillary artery: lateral and posterior are lateral, medial is behind
-2nd part: cords surround axillary artery and take their names from their relationship to it in this position

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18
Q

Branches of axillary artery

A

Parts are in relation to pec minor (superior, posterior, inferior)

1st part:
-Superior thoracic

2nd part:
-Thoracoacromial
-Lateral thoracic

3rd part:
-Subscapular
-Anterior circumflex humeral
-Posterior circumflex humeral

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19
Q

Which muscle overlies cords of brachial plexus?

A

Pec minor

20
Q

What are the nerves of the posterior abdominal wall and what do they supply?

A

-Ilioinguinal
–> internal oblique
–> medial thigh skin proximally
–> scrotum/penile root or mons pubis skin

Iliohypogastric
–> transversus abdominis, internal oblique
–> suprapubic skin

Genitofemoral
–> scrotal skin, skin overlying femoral triangle

21
Q

During what surgery can nerves of posterior abdominal wall be damaged?

A

Surgery to right colon if mobilisation too posterior:
–> All 3 (ilioinguinal, iliohypogastric, genitofemoral

Appendicectomy
–> iliohypogastric if incision extended laterally
–> denervation of internal oblique/transversus abdominis: more risk of direct inguinal hernia

Inguinal hernia repair
–> ilioinguinal

22
Q

Factors contributing to stability/instability of shoulder joint and ROM

A

Instability:
–> shallow glenoid

Stability:
–> rotator cuff muscles
–> surrounding tough fibrous capsule

ROM
–> ball and socket joint
–> scapula can also move relative to torso so can provide greater flexibility

23
Q

What are the relations of the inferior epigastric artery near its origin?

A

-Lies medial to deep inguinal ring
-Testicular vessels
-Vas deferens in males, round ligament in females

24
Q

What operative procedures carry greatest risk of injury to inferior epigastrics?

A

-Insertion of laparascopic ports: appendicectomy
-Extending incision medially open appendicectomy
-Formation of ileostomies and colostomies

25
Q

Where does inferior epigastric originate?

A

Just proximal to inguinal ligament

26
Q

HOw long is the oesophagus and what is its course?

A

-25cm
-Commences at C6, level with lower border cricoid cartilage
-Traverses posteiror mediastinum
-Enters abdomen through right crus diaphragm T10
-Enters stomach at T11

27
Q

What is the venous drainage of the oesophagus?

A

-Cervical: inferior thyroid vein
-Thoracic: azygous venous system
-Abdominal: oesophageal branches left gastric vein

28
Q

What is the lymphatic drainage of oesophagus

A

Cervical: deep cervical nodes
Thoracic: mediastinal nodes
Abdominal: nodes around left gastric artery

29
Q

If you were to perform an oeosphagectomy via a right sided thoracotomy, what structure would routinely require division to access the oesophagus once inside the chest cavity

A

Azygous vein

30
Q

What are the constrictions of the oesophagus?

A

-Cricoid cartilage: anterior relation, 15cm from incisors

-Arch of aorta: left relation, 22.5cm from incisors

-Left main bronchus: anteirior relation, 25cm from incisors

-Diaphragm: T10 vertebra 40cm from incisors

31
Q

What is the mediastinum?

A

-Space between the lungs
-Includes mediastinal pleura
-Bounded anteriorly by sternum and posteriorly by thoracic vertebral column
-Extends inferiorly from thoracic inlet to diaphragm

32
Q

What are the main subdivisions of the mediastinum?

A

Superior and inferior

INferior: anterior, middle, posterior

33
Q

What are the components of the circle of willis?

A

The two internal carotid arteries and two vertebral arteries form an anastomosis known as the Circle of Willis on the inferior surface of the brain. Each half of the circle is formed by:

  1. Anterior communicating artery
  2. Anterior cerebral artery
  3. Internal carotid artery
  4. Posterior communicating artery
  5. Posterior cerebral arteries and the termination of the basilar artery
34
Q

What are the branches of the vertebral artery

A

Posterior spinal artery
Anterior spinal artery
Posterior inferior cerebellar artery

35
Q

What are the branches of the basilar artery?

A

Anterior inferior cerebellar artery
Labyrinthine artery
Pontine arteries
Superior cerebellar artery
Posterior cerebral artery (at the point where it bifurcates)

36
Q

What are the branches of the internal carotid arteries?

A

Posterior communicating artery
Anterior cerebral artery
Middle cerebral artery
Anterior choroid artery

37
Q

What is the blood supply to the hip joint?

A

The femoral head is supplied by two vascular networks; the medial femoral circumflex artery and the inferior gluteal artery. These form an extracapsular anastomosis and then travel in the femoral neck to supply the femoral head. A small contribution also travels in the ligamentum teres, this is of greater importance is children. Because the vessels travel along the femoral neck, intra capsular fractures can displace these vessels.

38
Q

What are the parts of the sella turcica?

A

The tuberculum sellae (horn of the saddle) is a vertical elevation of bone. It forms the anterior wall of the sella turcica, and the posterior aspect of the chiasmatic sulcus (a groove running between the right and left optic canals).

The hypophysial fossa or pituitary fossa (seat of the saddle) sits in the middle of the sella turcica. It is a depression in the body of the sphenoid, which holds the pituitary gland.

The dorsum sellae (back of the saddle) forms the posterior wall of the sella turcica. It is a large square of bone, pointing upwards and forwards. It separates the middle cranial fossa from the posterior cranial fossa

The sella turcica is surrounded by the anterior and posterior clinoid processes. The anterior clinoid processes arise from the sphenoidal lesser wings, while the posterior clinoid processes are the superolateral projections of the dorsum sellae. They serve as attachment points for the tentorium cerebelli, a membranous sheet that divides the brain.

39
Q

which cranial nerve fossae are in which bone?

A

Bones and foramina
-Superior orbital fissure
-Foramen rotundum
-Foramen ovale
-Foramen spinosum

Temporal:
-stylomastoid foramen
-Carotid canal

Occipital
-Foramen magnum
-jugular foramen
-Hypoglossal canal

40
Q

Label the cranial nerve fossae

A

A Frontal air sinus
B Cribriform plate
C Optic canal
D Foramen rotundum
E Foramen ovale
F Jugular foramen
G Foramen magnum

41
Q

Structural differences between sigmoid colon and rectum

A

-Rectum does not have taenia coli
-Sigmoid colon is intraperitoneal, lower rectum is extraperitoneal
-Blood supply: sigmoid has sigmoidal branches from IMA. Rectum is supplied by superior rectal from IMA, middle rectal from internal iliac (anterior division) and inferior rectal from internal pudendal artery

42
Q

What is the lymphatic drainage of the rectum?

A

Mesorectal lymph nodes (superior to dentate line)
Inguinal nodes (inferior to dentate line)

43
Q

What structure lies immediately medial to deep inguinal ring?

A

Inferior epigastric artery and vein

44
Q

What structure lies posterior to inguinal ligament?

A

Femoral vessels

45
Q

Where does trachea commence and terminate?

A

Commences C6, bifurcates lower border of T4, upper border T5

46
Q

What is the course of the spinal accessory nerve in the posterior triangle?

A

-Emerges halfway down posterior SCM in posterior triangle of neck
-Passes obliquely downwards and posteriorly to pass beneath anterior aspect of trapezius 4-5cm above clavicle
-In posterior triangle it is closely related to superficial cervical lymph nodes

47
Q

What are the key differences between left and right renal vein?

A

-Right: very short
-Left: longer and related to SMA which overlies it
-Left receives tributary from gonadal vein

MRCS B Examinations and practical skills (13 decks)

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