EMRCS Flashcards
Which of the following nerves supplies the skin on the palmar aspect of the thumb?
Ulnar Median Radial Musculocutaneous None of the above
Answer: B
The median nerve supplies cutaneous sensation to this region.
The superior aspect of the vagina drains to which of the following lymph node groups?
Superficial inguinal nodes Para-aortic nodes Internal iliac nodes Meso rectal nodes Obturator nodes
Ans: C
The lymph vessels from the superior aspect of the vagina join the internal and external iliac nodes, those from the inferior aspect of the vagina drain to the superficial inguinal nodes.
Which of the following structures is not transmitted by the jugular foramen?
Hypoglossal nerve Accessory nerve Internal jugular vein Inferior petrosal sinus Vagus nerve
Ans: A
Contents of the jugular foramen:
Anterior: inferior petrosal sinus
Intermediate: glossopharyngeal, vagus, and accessory nerves
Posterior: sigmoid sinus (becoming the internal jugular vein) and some meningeal branches from the occipital and ascending pharyngeal arteries
The jugular foramen may be divided into three compartments:
Anterior compartment transmits the inferior petrosal sinus
Middle compartment transmits cranial nerves IX, X and XI
Posterior compartment transmits the sigmoid sinus
A 19 year old female is admitted with suspected meningitis. The House Officer is due to perform a lumbar puncture. What is the most likely structure first encountered when the needle is inserted?
Ligamentum flavum Denticulate ligament Dural sheath Pia Mater Supraspinous ligament
Ans: E
Lumbar punctures are performed to obtain cerebrospinal fluid. In adults, the procedure is best performed at the level of L3/L4 or L4/5 interspace. These regions are below the termination of the spinal cord at L1.
During the procedure the needle passes through:
The supraspinous ligament which connects the tips of spinous processes and the interspinous ligaments between adjacent borders of spinous processes
Then the needle passes through the ligamentum flavum, which may cause a give as it is penetrated
A second give represents penetration of the needle through the dura mater into the subarachnoid space. Clear CSF should be obtained at this point
A 45 year old motor cyclist sustains a tibial fracture and is noted to have anaesthesia of the web space between his first and second toes. Which of the nerves listed below is most likely to be compromised?
Superficial peroneal nerve Deep peroneal nerve Sural nerve Long saphenous nerve Tibial nerve
Ans: B
The deep peroneal nerve lies in the anterior muscular compartment of the lower leg and can be compromised by compartment syndrome affecting this area. It provides cutaneous sensation to the first web space. The superficial peroneal nerve provides more lateral cutaneous innervation.
A 63 year old lady is undergoing an axillary sentinel lymph node biopsy as part of her breast cancer treatment. Which of the structures listed below is most likely to be encountered?
Subclavian artery Intercostobrachial nerve Upper cord of the brachial plexus Lower cord of the brachial plexus Axillary nerve
Answer: B
This can be a challenging question. A particularly careless surgeon could encounter all of these. However, during a routine level 1 axillary exploration which is where the majority of sentinel nodes will be located, the nerves most commonly encountered are the intercostobrachial nerves.
A patient undergoes a femoral hernia repair and at operation the surgeon decides to enter the abdominal cavity to resect small bowel. She makes a transverse incision two thirds of the way between umbilicus and the symphysis pubis. Which of the structures listed below is least likely to be divided?
Rectus abdominis External oblique aponeurosis Peritoneum Fascia transversalis Posterior lamina of the rectus sheath
Answer: E
An incision at this level lies below the arcuate line and the posterior wall of the rectus sheath is deficient at this level.
What is the lymphatic drainage of the ovaries?
Internal iliac nodes Common iliac nodes Para-aortic nodes Para uterine nodes Inguinal nodes
Ans: C
The lymphatic drainage of the ovary follows the gonadal vessels and drainage is therefore to the para-aortic nodes.
A 35 year old farm labourer injures the posterior aspect of his hand with a mechanical scythe. He severs some of his extensor tendons in this injury. How many tunnels lie in the extensor retinaculum that transmit the tendons of the extensor muscles?
One Three Four Five Six
Answer: E
There are six tunnels, each lined by its own synovial sheath.
A 23 year old man undergoes an orchidectomy. The right testicular vein is ligated; into which structure does it drain?
Right renal vein Inferior vena cava Common iliac vein Internal iliac vein External iliac vein
Ans: B
The testicular venous drainage begins in the septa and these veins together with those of the tunica vasculosa converge on the posterior border of the testis as the pampiniform plexus. The pampiniform plexus drains to the testicular vein. The left testicular vein drains into the left renal vein. The right testicular vein drains into the inferior vena cava.
Which of the muscles listed below is not innervated by the median nerve?
Flexor pollicis brevis Lateral two lumbricals Pronator teres Opponens pollicis Adductor pollicis
Ans: E
Adductor pollicis is innervated by the ulnar nerve.
Medial two lumbricals innervated by the ulnar nerve.
A 44 year old lady is undergoing an abdominal hysterectomy and the ureter is identified during the ligation of the uterine artery. At which site does it insert into the bladder?
Posterior Apex Anterior Base Superior aspect of the lateral side
Ans: D
The ureters enter the bladder at the upper lateral aspect of the base of the bladder. They are about 5cm apart from each other in the empty bladder. Internally this aspect is contained within the bladder trigone.
A 23 year old man is involved in a fight outside a nightclub and sustains a laceration to his right arm. On examination, he has lost extension of the fingers in his right hand. Which of the nerves listed below is most likely to have been divided?
Median Musculocutaneous Radial Ulnar Axillary
Ans: C
The radial nerve supplies the extensor muscle group.
What is the correct embryological origin of the stapes?
First pharyngeal arch Second pharyngeal arch Third pharyngeal arch Fourth pharyngeal arch Fifth pharyngeal arch
Ans: B
Embryological origin stapes = 2nd pharyngeal arch
The incus is most likely to arise from the first arch.
A 72 year old man develops a foot drop after a revision total hip replacement. Which nerve is likely to have been affected?
Sciatic Femoral Obturator Superior gluteal Inferior gluteal
Ans: A
Whilst many of these nerves can be injured in hip surgery, for a foot drop to develop in this context (i.e. revision THR), the sciatic nerve is the most likely.
An injured axillary artery is ligated between the thyrocervical trunk of the subclavian and subscapular artery. Subsequent collateral circulation is likely to result in reversal of blood flow in which of the vessels listed below?
Circumflex scapular artery Transverse cervical artery Posterior intercostal arteries Suprascapular artery Profunda brachii artery
Ans: A
It’s an easy question really, we just made the wording difficult (on purpose). It is asking about the branches of the axillary artery and knowledge of the fact that there is an extensive collateral network around the shoulder joint. As a result, the occlusion of the proximal aspect of the circumflex humeral inflow (from the axillary artery) ceases and there is then retrograde flow through it from collaterals.
The circumflex scapular artery is a branch of the subscapular artery and normally supplies the muscle on the dorsal aspect of the scapula. In this instance, flow is reversed in the circumflex scapular and subscapular arteries forming a collateral circulation around the scapula.
A 20 year old lady presents with pain on the medial aspect of her thigh. Investigations show a large ovarian cyst. Compression of which of the nerves listed below is the most likely underlying cause?
Sciatic Genitofemoral Obturator Ilioinguinal Femoral cutaneous
Ans: C
The cutaneous branch of the obturator nerve is frequently absent. However, the obturator nerve is a recognised contributor to innervation of the medial thigh and large pelvic tumours may compress this nerve with resultant pain radiating distally.
A 73 year old man presents with a tumour at the central aspect of the posterior third of the tongue. To which of the following lymph node groups is it most likely to metastasise?
Submental Submandibular Ipsilateral deep cervical nodes Contralateral deep cervical nodes Bilateral deep cervical nodes
Ans: E
Posterior third tumours of the tongue commonly metastasise to the bilateral deep cervical lymph nodes
Tumours of the posterior third of the tongue will typically metastasise early and bilateral nodal involvement is well recognised, this is most often true of centrally located tumours and those adjacent to the midline as the lymph vessels may cross the median plane at this location.
A 6 month old child is brought to the surgical clinic because of non descended testes. What is the main structure that determines the descent path of the testicle?
Processus vaginalis Cremaster Mesorchium Inguinal canal Gubernaculum
Ans: E
The gubernaculum is a ridge of mesenchymal tissue that connects the testis to the inferior aspect of the scrotum. Early in embryonic development the gubernaculum is long and the testis are located on the posterior abdominal wall. During foetal growth the body grows relative to the gubernaculum, with resultant descent of the testis.
A 21 year old man undergoes surgical removal of an impacted 3rd molar. Post operatively, he is noted to have anaesthesia on the anterolateral aspect of the tongue. What is the most likely explanation?
Injury to the hypoglossal nerve Injury to the inferior alveolar nerve Injury to the lingual nerve Injury to the mandibular branch of the facial nerve Injury to the glossopharyngeal nerve
Ans: C
The lingual nerve is closely related to the third molar and up to 10% of patients undergoing surgical extraction of these teeth may subsequently develop a lingual neuropraxia. The result is anaesthesia of the ipsilateral anterior aspect of the tongue. The inferior alveolar nerve innervates the teeth themselves.
What is the most important structure involved in supporting the uterus?
Round ligament Broad ligament Uterosacral ligaments Cardinal ligaments Central perineal tendon
Ans: E
The central perineal tendon provides the main structural support to the uterus. Damage to this structure is commonly associated with the development of pelvic organ prolapse, even when other structures are intact.
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. Which of the following nerves has been affected?
Anterior interosseous Median Posterior interosseous Palmar cutaneous Ulnar
Ans: C
The 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.
A surgical resection specimen is analysed histologically. The pathologist comments that at the periphery of the resected specimen, oxyphil cells are identified. In which of the structures listed below are these cells typically found?
Thymus Thyroid gland Parathyroid gland Lymph node Adrenal gland
Ans: C
Oxyphil cells are typically found in parathyroid glands
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?
Gracilis Sural nerve Nerve to semimembranosus Popliteal artery Common peroneal nerve
Ans: E
The 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.
What is the lymphatic drainage of the male spongy urethra?
External iliac nodes Internal iliac nodes Para aortic nodes Deep inguinal nodes Meso rectal nodes
Ans: D
The lymphatic drainage of the spongy urethra and the glans penis is to the deep inguinal nodes. The prostatic and membranous urethra drains to the internal iliac nodes.
A 34 year old lady suffers from hyperparathyroidism. The right inferior parathyroid is identified as having an adenoma and is scheduled for resection. From which of the following embryological structures is it derived?
Second pharyngeal pouch Third pharyngeal pouch Fourth pharyngeal pouch First pharyngeal pouch None of the above
Ans: B
The inferior parathyroid is a derivative of the third pharyngeal pouch. The superior parathyroid originates from the fourth pharyngeal pouch.
A 23 year old man falls and slips at a nightclub. A shard of glass penetrates the skin at the level of the medial epicondyle, which of the following sequelae is least likely to occur?
Atrophy of the first dorsal interosseous muscle Difficulty in abduction of the the 2nd, 3rd, 4th and 5th fingers Claw like appearance of the hand Loss of sensation on the anterior aspect of the 5th finger Partial denervation of flexor digitorum profundus
Ans: C
Injury to the ulnar nerve in the mid to distal forearm will typically produce a claw hand. This consists of flexion of the 4th and 5th interphalangeal joints and extension of the metacarpophalangeal joints. The effects are potentiated when flexor digitorum profundus is not affected, and the clawing is more pronounced.More proximally sited ulnar nerve lesions produce a milder clinical picture owing to the simultaneous paralysis of flexor digitorum profundus (ulnar half).
This is the ‘ulnar paradox’, due to the more proximal level of transection the hand will typically not have a claw like appearance that may be seen following a more distal injury. The first dorsal interosseous muscle will be affected as it is supplied by the ulnar nerve.
A 56 year old man is undergoing a superficial parotidectomy for a pleomorphic adenoma. During the dissection of the parotid, which of the following structures will be encountered lying most superficially?
Facial nerve External carotid artery Occipital artery Maxillary artery Retromandibular vein
Ans: A
Most superficial structure on the parotid gland = facial nerve
The facial nerve is the most superficial structure in the parotid gland. Slightly deeper to this lies the retromandibular vein, with the arterial layer lying most deeply.
A 43 year old man is stabbed outside a nightclub. He suffers a transection of his median nerve just as it leaves the brachial plexus. Which of the following features is least likely to ensue?
Ulnar deviation of the wrist Complete loss of wrist flexion Loss of pronation Loss of flexion at the thumb joint Inability to oppose the thumb
Ans: B
Loss of the median nerve will result in loss of function of the flexor muscles. However, flexor carpi ulnaris will still function and produce ulnar deviation and some residual wrist flexion. High median nerve lesions result in complete loss of flexion at the thumb joint.
A 78 year old man is due to undergo an endarterectomy of the internal carotid artery. Which of the following nervous structures are most at risk during the dissection?
Recurrent laryngeal nerve Sympathetic chain Hypoglossal nerve Phrenic nerve Lingual nerve
Ans: C
Nerves at risk during a carotid endarterectomy:
Hypoglossal nerve
Greater auricular nerve
Superior laryngeal nerve
Which of the structures listed below articulates with the head of the radius superiorly?
Capitulum Trochlea Lateral epicondyle Ulna Medial epicondyle
Ans: A
The head of the radius articulates with the capitulum of the humerus.
Which of the following fascial structures encases the apex of the lungs?
Waldeyers fascia Sibsons fascia Pretracheal fascia Clavipectoral fascia None of the above
Ans: B
Sibson’s fascia overlies the apices of both lungs
The suprapleural fascia (Sibson’s fascia) runs from C7 to the first rib and overlies the apex of both lungs.It lies between the parietal pleura and the thoracic cage.
As regards the internal jugular vein, which of the following statements is untrue?
It lies within the carotid sheath It is the continuation of the sigmoid sinus The terminal part of the thoracic duct crosses anterior to it to insert into the right subclavian vein The hypoglossal nerve is closely related to it as it passes near the atlas The vagus nerve is closely related to it within the carotid sheath
Ans: C
Each jugular vein begins in the jugular foramen, where they are the continuation of the sigmoid sinus. They terminate at the medial end of the clavicle where they unite with the subclavian vein.
The vein lies within the carotid sheath throughout its course. Below the skull the internal carotid artery and last four cranial nerves are anteromedial to the vein. Thereafter it is in contact medially with the internal (then common) carotid artery. The vagus lies posteromedially.
A 28 year old man requires a urethral catheter to be inserted prior to undergoing a splenectomy. Where is the first site of resistance to be encountered on inserting the catheter?
Bulbar urethra Membranous urethra Internal sphincter Prostatic urethra Bladder neck
Ans: B
The membranous urethra is the least distensible portion of the urethra. This is due to the fact that it is surrounded by the external sphincter.
At the level of the wrist joint, which of the statements below best describes the relationship of the ulnar artery to the ulnar nerve?
It lies on its radial side It lies deep to it It lies superficial to it It lies on its ulnar side None of the above
Ans: A
In the middle of the forearm, the artery is overlapped by the flexor carpi ulnaris and on the flexor retinaculum it is covered by a superficial layer from that structure. In its distal two-thirds, flexor digitorum superficialis lies on its radial side, and the ulnar nerve is situated on its ulnar side.
A 24 year old man falls and sustains a fracture through his scaphoid bone. From which of the following areas does the scaphoid derive the majority of its blood supply?
From its proximal medial border From its proximal lateral border From its proximal posterior surface From the proximal end From the distal end
Ans: E
The blood supply to the scaphoid enters from a small non articular surface near its distal end. Transverse fractures through the scaphoid therefore carry a risk of non union.
A 21 year old man has an inguinal hernia and is undergoing a surgical repair. As the surgeons approach the inguinal canal they expose the superficial inguinal ring. Which of the following forms the lateral edge of this structure?
Inferior epigastric artery Conjoint tendon Rectus abdominis muscle External oblique aponeurosis Transversalis fascia
Ans: D
The external oblique aponeurosis forms the anterior wall of the inguinal canal and also the lateral edge of the superficial inguinal ring. The rectus abdominis lies posteromedially and the transversalis posterior to this.
A patient sustains damage to the median nerve during a carpal tunnel release. Which of the following muscles will be affected?
Abductor digiti minimi Abductor pollicis brevis Adductor pollicis Palmaris brevis Flexor digiti minimi brevis
Ans: B
Of the muscles listed, only the abductor pollicis brevis is innervated by the median. In questions like this one, ensure you don’t become confused between adductor and abductor.
Which of the following cranial venous sinuses is unpaired?
Transverse sinus Superior sagittal sinus Cavernous sinus Sigmoid sinus Inferior petrosal sinus
Ans: B
The superior sagittal sinus is unpaired
Which of the following laryngeal tumours will not typically metastasise to the cervical lymph nodes?
Glottic Supraglottic Subglottic Transglottic Aryepiglottic fold
Ans: A
The vocal cords have no lymphatic drainage and therefore this region serves as a lymphatic watershed. The supraglottic part drains to the upper deep cervical nodes through vessels piercing the thyrohyoid membrane. The sub glottic part drains to the pre laryngeal, pre tracheal and inferior deep cervical nodes. The aryepiglottic and vestibular folds have a rich lymphatic drainage and will metastasise early.
Which of the following forms the medial wall of the femoral canal?
Pectineal ligament Adductor longus Sartorius Lacunar ligament Inguinal ligament
Ans: D
Borders of the femoral canal Laterally Femoral vein Medially Lacunar ligament Anteriorly Inguinal ligament Posteriorly Pectineal ligament
Which of the structures listed below accompanies the aorta as it traverses the aortic hiatus?
Oesophagus Thoracic duct Vagal trunks Right phrenic nerve Left phrenic nerve
Ans: B
The aorta is accompanied by the thoracic duct as it traverses the aortic hiatus. The vagal trunks accompany the oesophagus which passes through the muscular part of the diaphragm on the right. The right phrenic nerve accompanies the IVC as it passes through the caval opening. The left phrenic nerve passes through the muscular part of the diaphragm anterior to the central tendon on the left.
A 67 year old man is undergoing a transurethral resection of a bladder tumour using diathermy. Suddenly during the procedure the patient’s thigh begins to twitch. Stimulation of which of the following nerves is the most likely cause?
Femoral Pudendal Sciatic Obturator Gluteal
Ans: D
The obturator nerve is most closely related to the bladder
A 5 year old boy is playing with some small ball bearings. Unfortunately, he inhales one. To which of the following lung regions is the ball most likely to settle?
Right lower lobe Left main bronchus Right upper lobe Left lower lobe None of the above
Ans: A
As the most dependent part of the right lung a small object is most likely to lodge here. Most objects will preferentially enter the right lung owing to the angle the right main bronchus takes from the trachea.
A patient presents with superior vena caval obstruction. How many collateral circulations exist as alternative pathways of venous return?
None One Two Three Four
Ans: E
There are 4 collateral venous systems:
Azygos venous system
Internal mammary venous pathway
Long thoracic venous system with connections to the femoral and vertebral veins (2 pathways)
Despite this, venous hypertension still occurs.
An 18 year old man is cutting some plants when a small piece of vegetable matter enters his eye. His eye becomes watery. Which of the following is responsible for relaying parasympathetic neuronal signals to the lacrimal apparatus?
Pterygopalatine ganglion Otic ganglion Submandibular ganglion Ciliary ganglion None of the above
Ans: A
The parasympathetic fibres to the lacrimal apparatus transit via the pterygopalatine ganglion.
Which of the nerves listed below is directly responsible for the innervation of the lateral aspect of flexor digitorum profundus?
Ulnar nerve Anterior interosseous nerve Radial nerve Median nerve Posterior interosseous nerve
Ans: B
The anterior interosseous nerve is a branch of the median nerve and is responsible for innervation of the lateral aspect of the flexor digitorum profundus.
A 45 year old lady is undergoing a Whipples procedure for carcinoma of the pancreatic head. The bile duct is transected. Which of the following vessels is mainly responsible for the blood supply to the bile duct remnant?
Cystic artery Hepatic artery Portal vein Left gastric artery None of the above
Ans: B
The bile duct has an axial blood supply which is derived from the hepatic artery and from retroduodenal branches of the gastroduodenal artery. Unlike the liver there is no contribution by the portal vein to the blood supply of the bile duct. Damage to the hepatic artery during a difficult cholecystectomy is a recognised cause of bile duct strictures. In this scenario the distal vessels have been removed as the patient is undergoing a resection.
What vessel is the origin of the middle rectal artery?
Aorta Inferior mesenteric artery Superior mesenteric artery Internal iliac artery Internal pudendal artery
Ans: D
The rectum is supplied by 3 main vessels
Superior rectal artery from inferior mesenteric artery
Middle rectal artery from the internal iliac artery
Inferior rectal artery from the internal pudendal artery
Which of the structures listed below are most closely related to the axillary nerve within the quadrangular space?
Posterior circumflex humeral vessels Axillary artery Anterior circumflex humeral vessels Radial artery Acromiothoracic artery
Ans: A
The posterior circumflex humeral vessels which are branches of the axillary artery are related to the axillary nerve within the quadrangular space.
A 43 year old lady is undergoing a total thyroidectomy for an extremely large goitre. The surgeons decide that access may be improved by division of the infra hyoid strap muscles. At which of the following sites should they be divided?
In their upper half In their lower half In the middle At their origin from the hyoid At the point of their insertion
Ans: A
Should the strap muscles require division during surgery they should be divided in their upper half. This is because their nerve supply from the ansa cervicalis enters in their lower half.
A 7 year old boy presents with right iliac fossa pain and there is a clinical suspicion that appendicitis is present. From which of the following embryological structures is the appendix derived?
Vitello-intestinal duct Uranchus Foregut Hindgut Midgut
Ans: E
The appendix is derived from the midgut
A 22 year old women has recently undergone a surgical excision of the submandibular gland. She presents to the follow up clinic with a complaint of tongue weakness on the ipsilateral side to her surgery. Which nerve has been damaged?
Hypoglossal nerve Lingual nerve Inferior alveolar nerve Facial nerve Lesser petrosal nerve
Ans: A
Three cranial nerves may be injured during submandibular gland excision.
Marginal mandibular branch of the facial nerve
Lingual nerve
Hypoglossal nerve
Hypoglossal nerve damage may result in paralysis of the ipsilateral aspect of the tongue. The nerve itself lies deep to the capsule surrounding the gland and should not be injured during an intracapsular dissection. The lingual nerve is probably at greater risk of injury. However, the effects of lingual nerve injury are sensory rather than motor.
You decide to take an arterial blood gas from the femoral artery. Where should the needle be inserted to gain the sample?
1-2 cm inferiorly to the mid point of the inguinal ligament 1-2cm inferiorly to the mid inguinal point 2cm inferomedially to the pubic tubercle 2cm superomedially to the pubic tubercle 3cm inferolaterally to the deep inguinal ring
Ans: B
The mid inguinal point is midway between the anterior superior iliac spine and the symphysis pubis
The mid inguinal point in the surface marking for the femoral artery.
A 67 year old man undergoes a carotid endarterectomy and seems to recover well following surgery. When he is reviewed on the ward post operatively he complains that his voice is hoarse. What is the most likely cause?
Damage to the accessory nerve Damage to the cervical plexus Damage to the glossopharyngeal nerve Damage to the hypoglossal nerve Damage to the vagus
Ans: E
Many of these nerves are at risk of injury during carotid surgery. However, only damage to the vagus would account for a hoarse voice.
A 25 year old man has an inguinal hernia, which of the following structures must be divided (at open surgery) to gain access to the inguinal canal?
Transversalis fascia External oblique aponeurosis Conjoint tendon Rectus abdominis Inferior epigastric artery
Ans: B
This question is asking what structure forms the anterior wall of the inguinal canal. The anterior wall is formed by the external oblique aponeurosis. Once this is divided the canal is entered, the cord can be mobilised and a hernia repair performed. The transversalis fascia and conjoint tendons form the posterior wall and would not routinely be divided to gain access to the inguinal canal itself.
Which muscle initiates abduction of the shoulder?
Infraspinatus Latissimus dorsi Supraspinatus Deltoid Teres major
Ans: C
The intermediate portion of the deltoid muscle is the chief abductor of the humerus. However, it can only do this after the movement has been initiated by supraspinatus. Damage to the tendon of supraspinatus is a common form of rotator cuff disease.
Which of the following nerves is most commonly damaged during a superficial parotidectomy?
Greater auricular Facial Greater occipital Accessory Opthalmic branch of the trigeminal
Ans: A
The greater auricular nerve and in particular its lobular branch is commonly injured in parotid surgery and consent usually makes particular reference to this. In a superficial parotidectomy, the facial nerve should not be injured and this is less common than a greater auricular nerve injury.
A 34 year old man is shot in the postero- inferior aspect of his thigh. Which of the following lies at the most lateral aspect of the popliteal fossa?
Popliteal artery Popliteal vein Common peroneal nerve Tibial nerve Small saphenous vein
Ans: C
The contents of the popliteal fossa are (from medial to lateral): Popliteal artery Popliteal vein Tibial nerve Common peroneal nerve
The sural nerve is a branch of the tibial nerve and usually arises at the inferior aspect of the popliteal fossa. However, its anatomy is variable.
A 67 year old man has an abdominal aortic aneurysm which displaces the left renal vein. Which branch of the aorta is most likely to affected at this level?
Inferior mesenteric artery Superior mesenteric artery Coeliac axis Testicular artery None of the above
Ans: B
The left renal vein lies behind of the SMA as it branches off the aorta. Whilst juxtarenal AAA may sometimes require the division of the left renal vein, direct involvement of the SMA may require a hybrid surgical bypass and subsequent endovascular occlusion.
An 21 year old man undergoes an uncomplicated tonsillectomy for recurrent attacks of tonsillitis. Post operatively he complains of otalgia. Which nerve is responsible?
Trigeminal Hypoglossal Glossopharyngeal Facial Vagus
Ans: C
The glossopharyngeal nerve supplies this area and the ear and otalgia may be the result of referred pain.
A 12 year old boy undergoes surgery for recurrent mastoid infections. Post operatively he complains of an altered taste sensation. Which of the following nerves has been injured?
Glossopharyngeal Greater petrosal Olfactory Trigeminal Chorda tympani
Ans: E
The chorda tympani branch of the facial nerve passes forwards through itrs canaliculus into the middle ear, and crosses the medial aspect of the tympanic membrane. It then passes antero-inferiorly in the infratemporal fossa. It distributes taste fibres to the anterior two thirds of the tongue.
What is the origin of the superior gluteal artery?
Internal iliac artery External iliac artery Femoral artery Common iliac artery Circumflex femoral artery
Ans: A
The inferior gluteal artery arises from the anterior trunk of the internal iliac artery
The superior gluteal artery arises from the posterior trunk of the internal iliac artery
The first root of the brachial plexus commonly arises at which of the following levels?
C6 C5 C3 C2 C8
Ans: B
It begins at C5 and has 5 roots. It ends with a total of 15 nerves of these 5 are the main nerves to the upper limb (axillary, radial, ulnar, musculocutaneous and median)
What is the anatomical level of the transpyloric plane?
T11 T12 L1 L4 T10
Ans: C
Which of the nerves listed below is responsible for the innervation of gluteus maximus?
Inferior gluteal nerve Superior gluteal nerve Posterior femoral cutaneous nerve Sciatic nerve Perineal nerve
Ans: A
Superior gluteal nerve
Arises from dorsal surface of the sacral plexus (L4, 5, S1)
Passes into gluteal region together with superior gluteal vessels
Supplies gluteus medius and minimus
Inferior gluteal nerve
Arises from dorsal surface of sacral plexus (L5, S1 and S2)
Runs medial to the posterior femoral cutaneous nerve
Enters gluteal region at inferior border of piriformis
Supplies gluteus maximus
When the brachial plexus is injured in the axilla as a result of a crutch palsy, which of the nerves listed is most commonly affected?
Thoracodorsal nerve Suprascapular nerve Radial nerve Ulnar nerve Long thoracic nerve
Ans: C
The radial nerve is most commonly injured and results in a wrist drop. The ulnar nerve arises from the medial cord and is rarely affected as a result of this injury mechanism.
A 35 year old man falls and sustains a fracture to the medial third of his clavicle. Which vessel is at greatest risk of injury?
Subclavian vein Subclavian artery External carotid artery Internal carotid artery Vertebral artery
Ans: A
The subclavian vein lies behind subclavius and the medial part of the clavicle. It rests on the first rib, below and in front of the third part of the subclavian artery, and then on scalenus anterior which separates it from the second part of the artery (posteriorly).
The pudendal canal is a fascial canal located on the lateral wall of the ischioanal fossa. In this location, it lies on the inferior border of which of the following muscles?
Coccygeus Obturator internus Pubococcygeus Iliococcygeus Piriformis
Ans: B
The coccygeus, pubococcygeus and iliococcygeus form part of the pelvic diaphragm and are not related to it. The piriformis exits the pelvis via the greater sciatic foramen and is not associated with the canal in the ischiorectal fossa.
Where are the greatest proportion of musculi pectinati found?
Right ventricle Left ventricle Right atrium Pulmonary valve Aortic valve
Ans: C
The musculi pectinati are found in the atria, hence the reason that the atrial walls in the right atrium are irregular anteriorly.
The musculi pectinati of the atria are internal muscular ridges on the anterolateral surface of the chambers and they are only present in the area derived from the embryological true atrium.
What is the lymphatic drainage of the upper ureter?
Common iliac nodes Para aortic nodes External iliac nodes Internal iliac nodes Meso colic nodes
Ans: B
The upper ureter drains to the para-aortic nodes, the lower ureter drains to the common iliac nodes.
Which of the nerves listed below provides sensory innervation to the skin overlying the lateral aspect of the nose?
Infratrochlear nerve Zygomatic nerve Nasopalatine nerve Lateral nasal branches of the ethmoidal nerve Frontal nerve
Ans: D
The lateral aspect of the external nose is innervated by lateral nasal branches of the anterior ethmoidal nerve. The ethmoidal nerve is a branch of the nasociliary nerve which is one of the divisions of the trigeminal.
Which of the following statements relating to the right phrenic nerve is false?
It lies deep to the prevertebral layer of deep cervical fascia Crosses posterior to the 2nd part of the subclavian artery It runs on the anterior surface of the scalene muscle On the right side it leaves the mediastinum via the vena cava hiatus at a level of T8 The right phrenic nerve passes over the right atrium
Ans: B
Path
The phrenic nerve passes with the internal jugular vein across scalenus anterior. It passes deep to prevertebral fascia of deep cervical fascia.
Left: crosses anterior to the 1st part of the subclavian artery.
Right: Anterior to scalenus anterior and crosses anterior to the 2nd part of the subclavian artery.
On both sides, the phrenic nerve runs posterior to the subclavian vein and posterior to the internal thoracic artery as it enters the thorax.
Right phrenic nerve
In the superior mediastinum: anterior to right vagus and laterally to superior vena cava
Middle mediastinum: right of pericardium
It passes over the right atrium to exit the diaphragm at T8
Left phrenic nerve
Passes lateral to the left subclavian artery, aortic arch and left ventricle
Passes anterior to the root of the lung
Pierces the diaphragm alone
Which of the following structures separates the subclavian artery and vein?
Digastric muscle Prevertebral fascia Anterior scalene muscle Middle scalene muscle Omohyoid
Ans: C
The anterior scalene muscle is an important anatomical landmark and separates the subclavian vein (anterior) from the subclavian artery (posterior).
A 33 year old man is stabbed in the right chest and undergoes a thoracotomy. The right lung is mobilised and the pleural reflection at the lung hilum is opened. Which of the structures listed below does not lie within this region?
Pulmonary artery Azygos vein Pulmonary vein Bronchus None of the above
Ans: B
The pleural reflections encase the hilum of the lung and continue inferiorly as the pulmonary ligament. It encases the pulmonary vessels and bronchus. The azygos vein is not contained within it.
A 56 year old man requires long term parenteral nutrition and the decision is made to insert a PICC line for long term venous access. This is inserted into the basilic vein at the region of the elbow. As the catheter is advanced, into which venous structure is the tip of the catheter most likely to pass from the basilic vein?
Subclavian vein Axillary vein Posterior circumflex humeral vein Cephalic vein Superior vena cava
Ans: B
The basilic vein drains into the axillary vein and although PICC lines may end up in a variety of fascinating locations the axillary vein is usually the commonest site following from the basilic. The posterior circumflex humeral vein is encountered prior to the axillary vein. However, a PICC line is unlikely to enter this structure because of its angle of entry into the basilic vein.
An individual is noted to have a left sided superior vena cava. By which pathway is blood from this system most likely to enter the heart?
Via the coronary sinus Via the azygos venous system and into the superior vena cava Via anomalies in the pumonary vascular bed Via the left atrium and persistent foramen ovale Directly into the roof of the right atrium
Ans: A
Persistent left superior vena cava is the most common anomaly of the thoracic venous system. It is prevalent in 0.3% of the population and is a benign entity of failed involution during embryogenesis.
An 8 year old boy falls onto an outstretched hand and sustains a supracondylar fracture. In addition to a weak radial pulse the child is noted to have loss of pronation of the affected hand. Which nerve is compromised?
Median Radial Ulnar Musculocutaneous Axillary
Ans: A
This is a common injury in children. In this case the angulation and displacement have resulted in median nerve injury.
A 40 year old lady trips and falls through a glass door and sustains a severe laceration to her left arm. Amongst her injuries it is noticed that she has lost the ability to adduct the fingers of her left hand. Injury to which of the following nerves is most likely to account for her examination findings?
Ulnar Median Radial Musculocutaneous Axillary
Ans: A
The interossei are supplied by the ulnar nerve.
A 53 year old man is undergoing a radical gastrectomy for carcinoma of the stomach. Which of the following structures will need to be divided to gain access to the coeliac axis?
Lesser omentum Greater omentum Falciform ligament Median arcuate ligament Gastrosplenic ligament
Ans: A
The lesser omentum will need to be divided. During a radical gastrectomy this forms one of the nodal stations that will need to be taken.
A 76 year old man complains of symptoms of claudication. The decision is made to measure his ankle brachial pressure index. The signal from the dorsalis pedis artery is auscultated with a hand held doppler device. This vessel is the continuation of which of the following?
Posterior tibial artery Anterior tibial artery Peroneal artery Popliteal artery None of the above
Ams: B
The dorsalis pedis is a continuation of the anterior tibial artery.
A 67 year old man is due to undergo a revisional total hip replacement using a posterior approach. After dividing gluteus maximus in the line of its fibres there is brisk arterial bleeding. Which of the following vessels is likely to be responsible?
Profunda femoris artery External iliac artery Internal iliac artery Obturator artery Inferior gluteal artery
Ans: E)
The inferior gluteal artery runs on the deep surface of the gluteus maximus muscle. It is a branch of the internal iliac artery. It is commonly divided during the posterior approach to the hip joint.
A 17 year old lady presents with right iliac fossa pain and diagnosed as having acute appendicitis. You take her to theatre to perform a laparoscopic appendicectomy. During the procedure the scrub nurse distracts you and you inadvertently avulse the appendicular artery. The ensuing haemorrhage is likely to be supplied directly from which vessel?
Inferior mesenteric artery Superior mesenteric artery Ileo-colic artery Internal iliac artery None of the above
Ans: C
The appendicular artery is a branch of the ileocolic artery.
Which of the vessels listed below is the most inferiorly sited single aortic branch?
Common iliac artery Inferior mesenteric artery Superior mesenteric artery Gonadal artery Median sacral artery
Ans: E
The median sacral artery leaves the aorta a little above its bifurcation. It descends in the midline anterior to L4 and L5.
A 63 year old man who smokes heavily presents with dyspepsia. He is tested and found to be positive for helicobacter pylori infection. One evening he has an episode of haematemesis and collapses. What is the most likely vessel to be responsible?
Portal vein Short gastric arteries Superior mesenteric artery Gastroduodenal artery None of the above
Ans: D
He is most likely to have a posteriorly sited duodenal ulcer. These can invade the gastroduodenal artery and present with major bleeding. Although gastric ulcers may invade vessels they do not tend to produce major bleeding of this nature.
Which of the structures listed below are not located within the mediastinum?
Thymus Heart Great vessels Arch of azygos vein Vertebral bodies
Ans: E
The vertebral bodies lie outside of the mediastinum, as do the lungs.
A 22 year old man is stabbed in the chest at the level of the junction between the sternum and manubrium. Which structure is at greatest risk?
Left atrium Oesophagus Thyroid gland Inferior vena cava Aortic arch
Ans: E
At the level of the Angle of Louis (Manubriosternal angle), is the surface marking for the aortic arch. The oesophagus is posteriorly located and at less risk.
Which of these nerves passes through the greater and lesser sciatic foramina?
Pudendal nerve Sciatic nerve Superior gluteal nerve Inferior gluteal nerve Posterior cutaneous nerve of the thigh
Ans: A
Structures passing through the lesser and greater sciatic foramina (medial to lateral): PIN
Pudendal nerve
Internal pudendal artery
Nerve to obturator internus
Which of the following is not found within the deep perineal pouch in an adult male?
Pudendal nerve Dorsal nerve of the penis Sphinter urethrae Urethral artery Obturator nerve
Ans: E
Contents of the deep perineal pouch
Urethral sphincter
Transversus perinei
Dorsal nerve of penis, muscular branches of the perineal nerve
Deep and dorsal arteries of penis, stem of origin of artery to the bulb of penis, urethral artery.
A cervical rib is due to which of the following?
Hyperplasia of the annulus fibrosus Proliferation of the nucleus pulposus Fusion of the transverse processes of the 6th and 7th cervical vertebrae An accessory cervical vertebra Elongation of the transverse processes of the 7th cervical vertebra
Ans: E
Cervical ribs occur as a result of the elongation of the transverse process of the 7th cervical vertebra. It is usually a fibrous band that attaches to the first thoracic rib.
Which of the structures listed below is not a content of the carotid sheath?
Internal jugular vein Internal carotid artery Vagus nerve Recurrent laryngeal nerve Common carotid artery
Ans: D
Contents of carotid sheath: Common carotid artery Internal carotid artery Internal jugular vein Vagus nerve
A 28 year old rugby player injures his right humerus and on examination is noted to have a minor sensory deficit overlying the point of deltoid insertion into the humerus. Which of the nerves listed below is most likely to have been affected?
Radial Axillary Musculocutaneous Median Subscapular
Ans: B
This patch of skin is supplied by the axillary nerve
A 22 year old man is undergoing a wedge excision of his great toenail. As the surgeon passes a needle into the area to administer local anaesthetic, the patient notices a sharp pain. By which pathway will this sensation be conveyed to the central nervous system?
Anterior corticospinal tract Posterior spinocerebellar tract Cuneate fasciculus Vestibulospinal tract Spinothalamic tract
Ans: E
Spinothalamic tract- Pain and temperature
Vestibulospinal tract- Motor neuronal signals relating to posture
Cuneate fasciculus- Fine touch, pressure and proprioception
Posterior spinocerebellar tract- Proprioceptive signals to cerebellum
Anterior corticospinal tract- Conveys motor signals from precentral gyrus to motor cells within the cord
A 73 year old lady is admitted with brisk rectal bleeding. Despite attempts at resuscitation the bleeding proceeds to cause haemodynamic compromise. An upper GI endoscopy is normal. A mesenteric angiogram is performed and a contrast blush is seen in the region of the sigmoid colon. The radiologist decides to embolise the vessel supplying this area. At what spinal level does it leave the aorta?
L2 L1 L4 L3 T10
Ans: D
The inferior mesenteric artery leaves the aorta at L3. It supplies the left colon and sigmoid. Its proximal continuation to communicate with the middle colic artery is via the marginal artery.
Inspection of the left ventricle reveals all except which of the following?
Papillary muscles Trabeculae carnae Chordae tendinae Conus arteriosus Openings of the venae cordis minimae
Ans: D
The conus arteriosus (infundibulum) is the smooth walled outflow tract of the right ventricle leading to the pulmonary trunk.
A 23 year old lady with troublesome axillary hyperhidrosis is undergoing a thorascopic sympathectomy to treat the condition. Which of the following structures will need to be divided to access the sympathetic trunk?
Intercostal vein Intercostal artery Parietal pleura Visceral pleura None of the above
Ans: C
The sympathetic chain lies posterior to the parietal pleura. During a thorascopic sympathetomy this structure will need to be divided. The intercostal vessels lie posteriorly. They may be damaged with troublesome bleeding but otherwise are best left alone as deliberate division will not improve surgical access.
In which space is a lumbar puncture performed?
Subdural space Epidural space Subarachnoid space Extradural space Intraventricular space
Ans: C
Samples of CSF are normally obtained by inserting a needle between the third and fourth lumbar vertebrae. The tip of the needle lies in the sub arachnoid space, the spinal cord terminates at L1 and is not at risk of injury. Clinical evidence of raised intracranial pressure is a contraindication to lumbar puncture.
A 21 year old man is stabbed in the antecubital fossa. A decision is made to surgically explore the wound. At operation the surgeon dissects down onto the brachial artery. A nerve is identified medially, which nerve is it likely to be?
Radial Recurrent branch of median Anterior interosseous Ulnar Median
Ans: E
A 65 year old man with long standing atrial fibrillation develops an embolus to the lower leg. The decision is made to perform an embolectomy, utilising a trans popliteal approach. After incising the deep fascia, which of the following structures will the surgeons encounter first on exploring the central region of the popliteal fossa?
Popliteal vein Common peroneal nerve Popliteal artery Tibial nerve None of the above
Ans: D
The tibial nerve lies superior to the vessels in the inferior aspect of the popliteal fossa. In the upper part of the fossa the tibial nerve lies lateral to the vessels, it then passes superficial to them to lie medially. The popliteal artery is the deepest structure in the popliteal fossa.
A 53 year old man is undergoing a distal pancreatectomy for trauma. Which of the following vessels is responsible for the arterial supply to the tail of the pancreas?
Splenic artery Pancreaticoduodenal artery Gastric artery Hepatic artery Superior mesenteric artery
Ans: A
Pancreatic head is supplied by the pancreaticoduodenal artery
Pancreatic tail is supplied by branches of the splenic artery
A 43 year old lady presents with varicose veins and undergoes a saphenofemoral disconnection, long saphenous vein stripping to the ankle and isolated hook phlebectomies. Post operatively she notices an area of numbness superior to her ankle. What is the most likely cause for this?
Sural nerve injury Femoral nerve injury Saphenous nerve injury Common peroneal nerve injury Superficial peroneal nerve injury
Ans: C
The sural nerve is related to the short saphenous vein. The saphenous nerve is related to the long saphenous vein below the knee and for this reason full length stripping of the vein is no longer advocated.
Which of the following muscles does not attach to the radius?
Pronator quadratus Biceps Brachioradialis Supinator Brachialis
Ans: E
The brachialis muscle inserts into the ulna. The other muscles are all inserted onto the radius.
A 25 year old man is stabbed in the upper arm. The brachial artery is lacerated at the level of the proximal humerus, and is being repaired. A nerve lying immediately lateral to the brachial artery is also lacerated. Which of the following is the nerve most likely to be?
Ulnar nerve Median nerve Radial nerve Intercostobrachial nerve Axillary nerve
Ans: B
The brachial artery begins at the lower border of teres major and terminates in the cubital fossa by branching into the radial and ulnar arteries. In the upper arm the median nerve lies closest to it in the lateral position. In the cubital fossa it lies medial to it.
What is the course of the median nerve relative to the brachial artery in the upper arm?
Medial to anterior to lateral Lateral to posterior to medial Medial to posterior to lateral Medial to anterior to medial Lateral to anterior to medial
Ans: E
Relations of median nerve to the brachial artery:
Lateral -> Anterior -> Medial
Which of the following is not a content of the cavernous sinus?
Oculomotor nerve Internal carotid artery Opthalmic nerve Abducens nerve Optic nerve
Ans: E
Mnemonic for contents of cavernous sinus:
O TOM CAT
Occulomotor nerve (III) Trochlear nerve (IV) Ophthalmic nerve (V1) Maxillary nerve (V2) Carotid artery Abducent nerve (VI) T
OTOM=lateral wall components
CA= components within sinus
Relations
Medial Lateral
Pituitary fossa
Sphenoid sinus Temporal lobe
Contents
Lateral wall components (from top to bottom:)
Oculomotor nerve
Trochlear nerve
Ophthalmic nerve
Maxillary nerve
Contents of the sinus (from medial to lateral:)
Internal carotid artery (and sympathetic plexus)
Abducens nerve
Surgical occlusion of which of these structures, will result in the greatest reduction in hepatic blood flow?
Portal vein Common hepatic artery Right hepatic artery Coeliac axis Left hepatic artery
Ans: A
The portal vein transports 70% of the blood supply to the liver, while the hepatic artery provides 30%. The portal vein contains the products of digestion. The arterial and venous blood is dispersed by sinusoids to the central veins of the liver lobules; these drain into the hepatic veins and then into the IVC. The caudate lobe drains directly into the IVC rather than into other hepatic veins.
A 43 year old man is due to undergo an excision of the sub mandibular gland. Which of the following incisions is the most appropriate for this procedure?
A transversely orientated incision 3cm below the mandible A transversely orientated incision immediately inferior to the mandible A vertical incision 3 cm anterior to the angle of the mandible and extending inferiorly A transversely orientated incision 2cm above the mandible A transversely orientated incision 12cm below the mandible
Ans: A
To access the sub mandibular gland a transverse incision 3cm below the mandible should be made. Incisions located higher than this may damage the marginal mandibular branch of the facial nerve.
A 5 year old boy presents with recurrent headaches. As part of his assessment he undergoes an MRI scan of his brain. This demonstrates enlargement of the lateral and third ventricles. Where is the most likely site of obstruction?
Foramen of Luschka Foramen of Magendie Foramen of Munro Aqueduct of Sylvius None of the above
Ans: D
The CSF fills the space between the arachnoid mater and pia mater (covering surface of the brain). The total volume of CSF in the brain is approximately 150ml. Approximately 500 ml is produced by the ependymal cells in the choroid plexus (70%), or blood vessels (30%). It is reabsorbed via the arachnoid granulations which project into the venous sinuses.
Circulation
- Lateral ventricles (via foramen of Munro)
- 3rd ventricle
- Cerebral aqueduct (aqueduct of Sylvius)
- 4th ventricle (via foramina of Magendie and Luschka)
- Subarachnoid space
- Reabsorbed into the venous system via arachnoid granulations into superior sagittal sinus
Composition Glucose: 50-80mg/dl Protein: 15-40 mg/dl Red blood cells: Nil White blood cells: 0-3 cells/ mm3
A 23 year old man presents with appendicitis. A decision is made to perform an appendicectomy. The operation commences with a 5cm incision centered on McBurneys point. Which of the following structures will be encountered first during the dissection?
External oblique aponeurosis Internal oblique muscle Transversalis fascia Rectus sheath Peritoneum
Ans: A
The external oblique will be encountered first in this location. The rectus sheath lies more medially.
The external oblique muscle is the most superficial of the abdominal wall muscles. It originates from the 5th to 12th ribs and passes inferomedially to insert into the linea alba, pubic tubercle and anterior half of the iliac crest. It is innervated by the thoracoabdominal nerves (T7-T11) and sub costal nerves.
A 23 year old man is undergoing an inguinal hernia repair. The surgeons mobilise the spermatic cord and place it in a hernia ring. A small slender nerve is identified superior to the cord. Which nerve is it most likely to be?
Iliohypogastric nerve Pudendal nerve Femoral branch of the genitofemoral nerve Ilioinguinal nerve Obturator nerve
Ans: D
The ilioinguinal nerve passes through the inguinal canal and is the nerve most commonly identified during hernia surgery. The genitofemoral nerve splits into two branches, the genital branch passes through the inguinal canal within the cord structures. The femoral branch of the genitofemoral nerve enters the thigh posterior to the inguinal ligament, lateral to the femoral artery. The iliohypogastric nerve pierces the external oblique aponeurosis above the superficial inguinal ring.
A 34 year old man undergoes excision of a sarcoma from the right buttock. During the procedure the sciatic nerve is sacrificed. Which of the following will not occur as a result of this process?
Loss of extension at the knee joint Foot drop Inability to extend extensor hallucis longus Unchanged sensation to the posterior aspect of the thigh Loss of sensation to the posterior aspect of the lower leg
Ans: A
Extension of the knee joint is caused by the obturator and femoral nerves. Sensation to the posterior aspect of the thigh is via the posterior cutaneous nerve of the thigh and this is a direct branch from the plexus itself.
Where does the spinal cord terminate in neonates?
L1 L2 L3 L4 L5
Ans: C
At the 3rd month the foetus’s spinal cord occupies the entire length of the vertebral canal. The vertebral column then grows longer exceeding the growth rate of the spinal cord. This results with the cord being at L3 at birth and L1-2 by adulthood.
A 45 year old man is undergoing a low anterior resection for a carcinoma of the rectum. Which of the following fascial structures will need to be divided to mobilise the mesorectum from the sacrum and coccyx?
Denonvilliers fascia Colles fascia Sibsons fascia Waldeyers fascia None of the above
Ans: D
Fascial layers surrounding the rectum:
Anteriorly lies the fascia of Denonvilliers
Posteriorly lies Waldeyers fascia
Waldeyers fascia separates the mesorectum from the sacrum and will need to be divided.
A 10 year old child has a grommet inserted for a glue ear. What type of epithelium is present on the external aspect of the tympanic membrane?
Stratified squamous Ciliated columnar Non ciliated columnar Non stratified squamous None of the above
Ans: A
The external aspect of the tympanic membrane is lined by stratified squamous epithelium. This is significant clinically in the development of middle ear infections when this type of epithelium may migrate inside the middle ear.
A 73 year old lady is admitted with acute mesenteric ischaemia. A CT angiogram is performed and a stenotic lesion is noted at the origin of the superior mesenteric artery. At which of the following levels does this branch from the aorta?
L1 L2 L3 L4 L5
Ans: A
The SMA leaves the aorta at L1. It passes under the neck of the pancreas prior to giving its first branch the inferior pancreatico-duodenal artery.
The following statements relating to the musculocutaneous nerve are true except?
It arises from the lateral cord of the brachial plexus It provides cutaneous innervation to the lateral side of the forearm If damaged, then extension of the elbow joint will be impaired It supplies the biceps muscle It runs beneath biceps
Ans: C
supplies biceps, brachialis and coracobrachialis. If damaged then elbow flexion will be impaired.
Which of the following structures does not pass through the foramen ovale?
Lesser petrosal nerve Accessory meningeal artery Maxillary nerve Emissary veins Otic ganglion
Ans: C
Mnemonic: OVALE
O tic ganglion V3 (Mandibular nerve:3rd branch of trigeminal) A ccessory meningeal artery L esser petrosal nerve E missary veins
Which of the cranial nerves listed below is least likely to carry parasympathetic fibres?
III VII IX X II
Ans: E
Cranial nerves carrying parasympathetic fibres
X IX VII III (1973)
A 72 year old man is undergoing an open abdominal aortic aneurysm repair. The aneurysm is located in a juxtarenal location and surgical access to the neck of aneurysm is difficult. Which of the following structures may be divided to improve access?
Cisterna chyli Transverse colon Left renal vein Superior mesenteric artery Coeliac axis
Ans: C
The left renal vein will be stretched over the neck of the anuerysm in this location and is not infrequently divided. This adds to the nephrotoxic insult of juxtarenal aortic surgery as a supra renal clamp is also often applied. Deliberate division of the Cisterna Chyli will not improve access and will result in a chyle leak. Division of the transverse colon will not help at all and would result in a high risk of graft infection. Division of the SMA is pointless for a juxtarenal procedure.
At which of the following levels does the inferior thyroid artery enter the thyroid gland?
C6 C2 C4 C3 C5
Ans: A
It enters the gland at C6.
An occlusion of the anterior cerebral artery may compromise the blood supply to the following structures except:
Medial inferior surface of the frontal lobe Corpus callosum Medial surface of the frontal lobe Olfactory bulb Brocas area
Ans: E
Brocas area is usually supplied by branches from the middle cerebral artery.
What is the longest part of the male urethra?
Membranous urethra Spongy urethra Prostatic urethra Urethra within the internal urethra orifice Urethra within the urethral crest
Ans: B
The spongy urethra is around 15cm long and is the longest part of the male urethra.
Parasympathetic fibres innervating the parotid gland originate from which of the following?
Submandibular ganglion Otic ganglion Ciliary ganglion Pterygopalatine ganglion None of the above
Ans: B
Secretion of saliva by the parotid gland is controlled by nerve fibres originating in the inferior salivatory nucleus; these leave the brain via the tympanic nerve (branch of glossopharyngeal nerve (CN IX), travel through the tympanic plexus (located in the middle ear), and then form the lesser petrosal nerve until reaching the otic ganglion. After synapsing in the Otic ganglion, the postganglionic (postsynaptic) fibres travel as part of the auriculotemporal nerve (a branch of the mandibular nerve (V3) to reach the parotid gland.
Following an oesophagogastrectomy the surgeons will anastomose the oesophageal remnant to the stomach, which of the following is not part of the layers that comprise the oesophageal wall?
Serosa Adventitia Muscularis propria Submucosa Mucosa
Ans: A
The oesophageal wall lacks the serosa layer
The wall lacks a serosa which can make the wall hold sutures less securely.
Which of the following structures suspends the spinal cord in the dural sheath?
Filum terminale Conus medullaris Ligamentum flavum Denticulate ligaments Anterior longitudinal ligament
Ans: D
The spinal cord is approximately 45cm in men and 43cm in women. The denticulate ligament is a continuation of the pia mater (innermost covering of the spinal cord) which has intermittent lateral projections attaching the spinal cord to the dura mater.
Where is the ‘safe triangle’ for chest drain insertion located?
4th intercostal space, mid axillary line 5th intercostal space, mid axillary line 4th intercostal space, mid scapular line 5th intercostal space, mid scapular line 4th intercostal space, mid clavicular line
Ans: B
‘Safe Triangle’ for chest drain insertion:
5th intercostal space, mid axillary line
A 32 year old rugby player is hit hard on the shoulder during a rough tackle. Clinically, his arm is hanging loose on the side. It is pronated and medially rotated. What structure is most likely to have been compromised?
Brachial trunks C5-6 Brachial trunks C6-7 Brachial trunks C8 - T1 Anterior interosseous nerve Posterior interosseous nerve
Ans: A
The patient has an Erb’s palsy involving brachial trunks C5-6.
Your consultant decides to perform an open inguinal hernia repair under local anaesthesia. Which of the following dermatomal levels will require blockade?
T10 T12 T11 S1 S2
Ans: B
See the figure
A 73 year old man undergoes an excision biopsy of a lymph node that is closely applied to sternocleidomastoid. This muscle is mobilized and a nerve that is present is damaged. Which muscle below is most likely to be affected?
Trapezius Rhomboid major Deltoid Supraspinatus Rhomboid minor
Ans: A
The accessory nerve has a number of lymph nodes applied to it near the sternocleidomastoid muscle. It is particularly at risk if SCM is mobilized. If injured, the trapezius muscle and SCM will be paralysed.
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. Which nerve has been affected?
Ulnar Anterior interosseous Posterior interosseous Median Musculocutaneous
Ans: A
The 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.
A 44 year old man is undergoing a parotidectomy and the surgeon is carefully preserving the facial nerve. Unfortunately his trainee then proceeds to divide it. Which of the following will not be affected as a result?
Taste sensation from anterior two thirds of the tongue Closing the ipsilateral eyelid Raising the ipsilateral side of the lip Ipsilateral corneal reflex None of the above
Ans: A
The chorda tympani branches inside the facial canal and will therefore be unaffected by this most unfortunate event! The corneal reflex is mediated by the opthalmic branch of the trigeminal nerve sensing the stimulus on the cornea, lid or conjunctiva; the facial nerve initiates the motor response of the reflex.
Which cranial nerve supplies general sensation to the posterior third of the tongue?
Facial Trigeminal Vagus Hypoglossal Glossopharyngeal
Ans: E
The glossopharyngeal nerve supplies general sensation to the posterior third of the tongue and contributes to the gag reflex.
A 45 year old lady develops severe back pain and on examination is found to have clinical evidence of an L5/ S1 radiculopathy. Her symptoms deteriorate and eventually a laminectomy is performed. During a posterior surgical approach the surgeons encounter a tough ligamentous structure lying anterior to the spinous processes. This structure is most likely to be the
Transverse spinal ligament Supraspinal ligament Anterior longitudinal ligament Ligamentum flavum Posterior longitudinal ligament
Ans: D
Which of the following does not pass through the superior orbital fissure?
Lacrimal nerve Abducens nerve Opthalmic artery Trochlear nerve Superior opthalmic vein
Ans: C
Mnemonic for the nerves passing through the supraorbital fissure:
Live Frankly To See Absolutely No Insult
Lacrimal Frontal Trochlear Superior Division of Oculomotor Abducens Nasociliary Inferior Division of Oculomotor nerve
An 18 year old man undergoes a tonsillectomy for attacks of recurrent acute tonsillitis. Whilst in recovery he develops a post operative haemorrhage. Which of the following vessels is the most likely culprit?
Facial vein External palatine vein External carotid artery Internal jugular vein None of the above
Ans: B
The external palatine vein lies immediately lateral to the tonsil and if damaged may be a cause of reactionary haemorrhage following tonsillectomy.
Which of the nerves listed below is responsible for providing innervation to the lower molar teeth?
Greater palatine nerve Nasopalatine nerve Inferior alveolar nerve Zygomatic nerve Mandibular nerve
Ans: C
The branches of the lower molar and premolar teeth are supplied by branches of the inferior alveolar nerve. Those of the canine and incisors by the incisive branch of the same nerve. The gingiva and supporting structures are innervated by the lingual nerve.
A patient is found to have an ischaemic left colon. Which artery arising from the aorta at around the level of L3 is most likely to account for this situation?
Superior mesenteric artery Inferior mesenteric artery Superior rectal artery Ileocolic artery Middle colic artery
Ans: B
At which level does the aorta traverse the diaphragm?
T10 T9 T8 T11 T12
A: E
Memory aid:
T8 (8 letters) = vena cava
T10 (10 letters) = oesophagus
T12 (12 letters) = aortic hiatus
What is the arterial blood supply to the lacrimal apparatus?
Nasociliary artery Supra orbital artery Internal carotid artery Ophthalmic artery Supra trochlear artery
A: D
The ophthalmic artery supplies the gland
A 24 year old lady is stabbed in the buttock. Following the injury the wound is sutured in the emergency department. Eight weeks later she attends the clinic, as she walks into the clinic room she has a waddling gait and difficulty with thigh abduction. On examination she has buttock muscle wasting. Which nerve has been injured?
Superior gluteal nerve Obturator nerve Sciatic nerve Femoral nerve Inferior gluteal nerve
Ans: A
Damage to the superior gluteal nerve will result in a Trendelenburg gait.
At which level is the hilum of the left kidney located?
L1 L2 T12 T11 L3
A: A
Remember L1 (‘left one’) is the level of the hilum of the left kidney
During a radical neck dissection, division of which of the following fascial layers will expose the ansa cervicalis?
Pretracheal fascia Carotid sheath Prevertebral fascia Investing layer of fascia Sibsons fascia
Ans: A
The ansa cervicalis lies anterior to the carotid sheath. It may be exposed by division of the pretracheal fascia at the posterolateral aspect of the thyroid gland. The pre vertebral fascia lies more posteriorly and division of the investing layer of fascia will not expose this nerve.
A 73 year old lady presents with symptoms of faecal incontinence. On examination she has weak anal sphincter muscles. What are the main nerve root values of the nerves supplying the external anal sphincter?
S2,3 L5, S1 S4,5 S5 S2,3,4
Ans: E
S2, 3, 4 Keeps the poo off the floor
The external anal sphincter is innervated by the inferior rectal branch of the pudendal nerve, this has root values of S2, 3 and the perineal branch of S4.
A 22 year old falls over and lands on a shard of glass. It penetrates the palmar aspect of his hand, immediately lateral to the pisiform bone. Which of the following structures is most likely to be injured?
Palmar cutaneous branch of the median nerve Lateral tendons of flexor digitorum superficialis Ulnar artery Flexor carpi radialis tendons Lateral tendons of flexor digitorum profundus
Ans: C
The ulnar nerve and artery are at most immediate risk in this injury.
A 72 year old man has a fall. He is found to have a fractured neck of femur and goes on to have a left hip hemiarthroplasty. Two months post operatively he is found to have an odd gait. When standing on his left leg his pelvis dips on the right side. There is no foot drop. What is the cause?
Sciatic nerve damage L5 radiculopathy Inferior gluteal nerve damage Previous poliomyelitis Superior gluteal nerve damage
Ans: E
This patient has a trendelenburg gait caused by damage to the superior gluteal nerve causing weakness of the abductor muscles. Classically a patient is asked to stand on one leg and the pelvis dips on the opposite side. The absence of a foot drop excludes the possibility of polio or L5 radiculopathy.
Which of the following structures lies posterior to the femoral nerve in the femoral triangle?
Adductor longus Pectineus Psoas major Iliacus None of the above
Ans: D
The iliacus lies posterior to the femoral nerve in the femoral triangle. The femoral sheath lies anterior to the iliacus and pectineus muscles.
Mnemonic for femoral nerve supply
(don’t) M I S V Q Scan for PE
M edial cutaneous nerve of the thigh
I ntermediate cutaneous nerve of the thigh
S aphenous nerve
V astus
Q uadriceps femoris
S artorius
PE ectineus
You are assisting in an open right adrenalectomy for a large adrenal adenoma. The consultant is distracted and you helpfully pull the adrenal into the wound to improve the view. Unfortunately this is followed by brisk bleeding. The vessel responsible for this is most likely to be:
Portal vein Phrenic vein Right renal vein Superior mesenteric vein Inferior vena cava
Ans: E
A 28 year old lady requires an episiotomy for a ventouse vaginal delivery. Which of the nerves listed below will usually be anaesthetised to allow the episiotomy?
Femoral Ilioinguinal Pudendal Genitofemoral Sacral plexus
Ans: C
The pudendal nerve innervates the posterior vulval area and is routinely blocked in procedures such as episiotomy.
A motorcyclist is involved in a road traffic accident. He suffers a complex humeral shaft fracture which is plated. Post operatively he complains of an inability to extend his fingers. Which of the following structures is most likely to have been injured?
Ulnar nerve Radial nerve Median nerve Axillary nerve None of the above
Ans: B
Mnemonic for radial nerve muscles: BEST
B rachioradialis
E xtensors
S upinator
T riceps
An enthusiastic surgical registrar undertakes his first solo splenectomy. The operation is far more difficult than anticipated and the registrar leaves a tube drain to the splenic bed at the end of the procedure. Over the following 24 hours approximately 500ml of clear fluid has entered the drain. Biochemical testing of the fluid is most likely to reveal:
Elevated creatinine Elevated triglycerides Elevated glucagon Elevated amylase None of the above
Ans: D
During splenectomy the tail of the pancreas may be damaged. The pancreatic duct will then drain into the splenic bed, amylase is the most likely biochemical finding. Glucagon is not secreted into the pancreatic duct.
A 48 year old lady is undergoing an axillary node clearance for breast cancer. Which of the structures listed below are most likely to be encountered during the axillary dissection?
Cords of the brachial plexus Thoracodorsal trunk Internal mammary artery Thoracoacromial artery None of the above
Ans: B
Beware of damaging the thoracodorsal trunk if a latissimus dorsi flap reconstruction is planned.
The thoracodorsal trunk runs through the nodes in the axilla. If injured it may compromise the function and blood supply to latissimus dorsi, which is significant if it is to be used as a flap for a reconstructive procedure.
A 56 year old lady is referred to the colorectal clinic with symptoms of pruritus ani. On examination a polypoidal mass is identified inferior to the dentate line. A biopsy confirms squamous cell carcinoma. To which of the following lymph node groups will the lesion potentially metastasise?
Internal iliac External iliac Mesorectal Inguinal None of the above
Ans: D
Lesions distal to the dentate line drain to the inguinal nodes. Occasionally this will result in the need for a block dissection of the groin.
Mesorectal lymph nodes (superior to dentate line) Inguinal nodes (inferior to dentate line)
Which of the following ligaments contains the artery supplying the head of femur in children?
Transverse ligament Ligamentum teres Iliofemoral ligament Ischiofemoral ligament Pubofemoral ligament
Ans: B
A 72 year old man develops a hydrocele which is being surgically managed. As part of the procedure the surgeons divide the tunica vaginalis. From which of the following is this structure derived?
Peritoneum External oblique aponeurosis Internal oblique aponeurosis Transversalis fascia Rectus sheath
A: A
The tunica vaginalis is derived from peritoneum, it secretes the fluid that fills the hydrocele cavity.
A 43 year old lady is donating her left kidney to her sister and the surgeons are harvesting the left kidney. Which of the following structures will lie most anteriorly at the hilum of the left kidney?
Left renal artery Left renal vein Left ureter Left ovarian vein Left ovarian artery
Ans: B
The renal veins lie most anteriorly, then artery and ureter lies posteriorly.
What is the sensory nerve supply to the angle of the jaw?
Maxillary branch of the trigeminal nerve Mandibular branch of the trigeminal nerve C3-C4 Greater auricular nerve (C2-C3) Buccal branch of the facial nerve
Ans: D
The trigeminal nerve is the major sensory nerve to the face except over the angle of the jaw. The angle of the jaw is innervated by the greater auricular nerve.
A 63 year old man is undergoing a coronary artery bypass procedure. During the median sternotomy which structure would routinely require division?
Parietal pleura Interclavicular ligament Internal mammary artery Brachiocephalic vein Left vagus nerve
Ans: B
The interclavicular ligament lies at the upper end of a median sternotomy and is routinely divided to provide access.
A 42 year old woman complains of a burning pain of her anterior thigh which worsens on walking. There is a positive tinel sign over the inguinal ligament. Which nerve is affected?
Ilioinguinal nerve Genitofemoral nerve Lateral cutaneous nerve of the thigh Femoral nerve Saphenous nerve
Ans: C
The lateral cutaneous nerve supplies sensation to the anterior and lateral aspect of the thigh. Entrapment is commonly due to intra and extra pelvic causes. Treatment involves local anaesthetic injections.
Which of the following structures separates the subclavian artery from the subclavian vein?
Scalenus anterior Scalenus medius Sternocleidomastoid Pectoralis major Pectoralis minor
Ans: A
The artery and vein are separated by scalenus anterior. This muscle runs from the transverse processes of C3,4,5 and 6 to insert onto the scalene tubercle of the first rib.
A 56 year old lady is due to undergo a left hemicolectomy for carcinoma of the splenic flexure. The surgeons decide to perform a high ligation of the inferior mesenteric vein. Into which of the following does this structure usually drain?
Portal vein Inferior vena cava Left renal vein Left iliac vein Splenic vein
Ans: E
The inferior mesenteric vein drains into the splenic vein, this point of union lies close to the duodenum and this surgical maneouvre is a recognised cause of ileus.
A 43 year old lady is due to undergo an axillary node clearance as part of treatment for carcinoma of the breast. Which of the following fascial layers will be divided during the surgical approach to the axilla?
Sibsons fascia Pre tracheal fascia Waldayers fascia Clavipectoral fascia None of the above
Ans: D
The clavipectoral fascia is situated under the clavicular portion of pectoralis major.
What are the boundaries of the ‘safe triangle’ for chest drain insertion?
Bounded by trapezius, latissimus dorsi, and laterally by the vertebral border of the scapula Bounded by latissimus dorsi, pectoralis major, line superior to the nipple and apex at the axilla Bounded by latissimus dorsi, serratus anterior, line superior to the nipple and apex at the axilla Bounded by trapezius, deltoid, rhomboid major and teres minor Bounded by trapezius, deltoid and latissimus dorsi
Ans: B
Where is a gomphoses type of fibrous joint typically found?
Teeth Skull Manubriosternum Ribs Femur
Ans: A
The vertebral artery traverses all of the following except?
Transverse process of C6 Transverse process of the axis Vertebral canal Foramen magnum Intervertebral foramen
Ans: E
The vertebral artery passes through the foramina which are located in the transverse processes of the cervical vertebra, it does not traverse the intervertebral foramen.
A 60 year old female attends the preoperative hernia clinic. She reports some visual difficulty. On examination she is noted to have a homonymous hemianopia. Where is the lesion most likely to be?
Frontal lobe Pituitary gland Parietal lobe Optic chiasm Optic tract
Ans: E
Lesions before optic chiasm:
Monocular vision loss = Optic nerve lesion
Bitemporal hemianopia = Optic chiasm lesion
Lesions after the optic chiasm:
Homonymous hemianopia = Optic tract lesion
Upper quadranopia = Temporal lobe lesion
Lower quadranopia = Parietal lobe lesion
A 34 year old male is being examined in the pre-operative assessment clinic. A murmur is identified in the 4th intercostal space just next to the left side of the sternum. From where is it most likely to have originated?
Mitral valve Aortic valve Pulmonary valve Right ventricular aneurysm Tricuspid valve
Ans: E
The tricuspid valve is generally referred to being best auscultated adjacent to the sternum. The plane of projected sound from the mitral area is best heard in the region of the cadiac apex.
Pulmonary valve
Left second intercostal space, at the upper sternal border
Aortic valve
Right second intercostal space, at the upper sternal border
Mitral valve
Left fifth intercostal space, just medial to mid clavicular line
Tricuspid valve
Left fourth intercostal space, at the lower left sternal border
Which of the following statements relating to quadratus lumborum is false?
Causes flexion of the thoracic spine Causes the rib cage to be pulled down Innervated by anterior primary rami of T12 and L1-3 Attached to the iliac crest Inserts into the 12th rib
Ans: A
Quadratus lumborum
Origin: Medial aspect of iliac crest and iliolumbar ligament
Insertion: 12th rib
Action: Pulls the rib cage inferiorly. Lateral flexion.
Nerve supply: Anterior primary rami of T12 and L1-3
The rectus abdominis causes flexion of the thoracic spine and therefore the statement suggesting that quaratus lumborum does so is incorrect.
A 23 year old climber falls and fractures his humerus. The surgeons decide upon a posterior approach to the middle third of the bone. Which of the following nerves is at greatest risk in this approach?
Ulnar Antebrachial Musculocutaneous Radial Intercostobrachial
Ans: D
The radial nerve wraps around the humerus and may be injured during a posterior approach. An IM nail may be preferred as it avoids the complex dissection needed for direct bone exposure.
A 67 year old man is undergoing an angiogram for gastro intestinal bleeding. The radiologist advances the catheter into the coeliac axis. At what spinal level does this vessel typically arise from the aorta?
T10 L3 L4 T12 None of the above
Ans: D
Which muscle does not insert on the medial surface of the greater trochanter?
Gemelli Obturator internus Piriformis Quadratus femoris Obturator externus
Ans: D
Mnemonic for muscle attachment on greater trochanter is POGO: Piriformis Obturator internus Gemelli Obturator externus
What is the largest branch of the brachial artery?
Radial artery Ulnar artery Profunda brachii artery Humeral nutrient artery Ulnar collateral artery
Ans: C
The profunda brachii artery is the largest branch and then continues in the radial groove of the humerus.
During a radical gastrectomy for carcinoma of the stomach the surgeons remove the omentum. What is the main source of its blood supply?
Ileocolic artery Superior mesenteric artery Gastroepiploic artery Middle colic artery Inferior mesenteric artery
Ans: C
A 38 year old lady is due to undergo a parathyroidectomy for hyperparathyroidism. At operation the inferior parathyroid gland is identified as being enlarged. A vessel is located adjacent to the gland laterally. This vessel is most likely to be the:
External carotid artery Common carotid artery Internal carotid artery External jugular vein None of the above
Ans: B
The common carotid artery is a lateral relation of the inferior parathyroid.
Relations
Laterally Common carotid
Medially Recurrent laryngeal nerve, trachea
Anterior Thyroid
Posterior Pretracheal fascia
A 45 year old man has a long femoral line inserted to provide CVP measurements. The catheter passes from the common iliac vein into the inferior vena cava. At which of the following vertebral levels will this occur?
L5 L4 S1 L3 L2
Ans: A
The common iliac veins fuse with the IVC at L5.
At which of the following levels does the inferior vena cava exit the abdominal cavity?
T6 T7 T10 T8 T12
Ans: D
Which of the following structures lies deepest in the popliteal fossa?
Popliteal artery Popliteal vein Tibial nerve Common peroneal nerve Popliteal lymph nodes
Ans: A
The common peroneal nerve exits the popliteal fossa along the medial border of the biceps tendon. Then the tibial nerve lies lateral to the popliteal vessels to pass posteriorly and then medially to them. The popliteal vein lies superficial to the popliteal artery, which is the deepest structure in the fossa.
How to remember the nerve roots of reflexes?
To remember nerve roots and their reflexes:
1-2 Ankle (S1-S2)
3-4 Knee (L3-L4)
5-6 Biceps (C5-C6)
7-8 Triceps (C7-C8)
