EMRCS ANATOMY 10 Flashcards
A 45 year old man is undergoing a left hemicolectomy. As the surgeons mobilise the left colon they identify a tubular structure lying at the inferior aspect of psoas major. What is it most likely to be?
Left ureter Left common iliac vein Left common iliac artery Left external iliac artery Left external iliac vein
Left ureter
The left ureter lies posterior to the left colon. The sigmoid colon and upper rectum may be more closely related to the iliac vessels. These are not typically found above L4.
Which muscle is not innervated by the trigeminal nerve?
Medial pterygoid Mylohyoid Stylohyoid Masseter Temporalis
Stylohyoid
Stylohyoid is innervated by the facial nerve.
A 42 year old woman is due to undergo a left nephroureterectomy for a transitional cell carcinoma involving the ureter. Which of the following structures is not related to the left ureter?
Round ligament of the uterus Internal iliac artery Ovarian artery Peritoneum Sigmoid mesocolon
Round ligament of the uterus
The ureter is not related to the round ligament of the uterus, it is related to the broad ligament and is within 1.5cm of the supravaginal part of the cervix.
Which of the following most commonly arises from the brachiocephalic artery?
Vertebral artery Subscapular artery Thyroidea ima artery Left Subclavian artery None of the above
Thyroidea ima artery
Other occasional branches include the thymic and bronchial branch.
A 28 year old man is undergoing an appendicectomy. The external oblique aponeurosis is incised and the underlying muscle split in the line of its fibres. At the medial edge of the wound is a tough fibrous structure. Entry to this structure will most likely encounter which of the following?
Internal oblique Rectus abdominis Transversus abdominis Linea alba Peritoneum
Rectus abdominis
This structure will be the rectus sheath and when entered the rectus abdominis muscle will be encountered.
A 35 year old man presents to the surgical clinic with a suspected direct inguinal hernia. These will pass through Hesselbach’s triangle. Which of the following forms the medial edge of this structure?
External oblique aponeurosis Inferior epigastric artery Rectus abdominis muscle Inferior epigastric vein Obturator nerve
Rectus abdominis muscle
Direct inguinal hernias pass through Hesselbachs triangle (although this is of minimal clinical significance!). Its medial boundary is the rectus muscle.
Which of the following muscles is not innervated by the ansa cervicalis?
Sternohyoid Mylohyoid Omohyoid Sternothyroid None of the above
Mylohyoid
Mylohyoid is innervated by the mylohyoid branch of the inferior alveolar nerve.
A 58 year old lady presents with a mass in the upper outer quadrant of the right breast. Which of the following statements relating to the breast is untrue?
The internal mammary artery provides the majority of its arterial supply Nipple retraction may occur as a result of tumour infiltration of the clavipectoral fascia The internal mammary artery is a branch of the subclavian artery Up to 70% of lymphatic drainage is to the ipsilateral axillary nodes None of the above
Nipple retraction may occur as a result of tumour infiltration of the clavipectoral fascia
Both skin dimpling and nipple retraction are features of breast malignancy. However, they usually occur as a result of tumour infiltration of the breast ligaments and ducts respectively. The clavipectoral fascia encases the axillary contents
Where are accessory spleens not found?
Gonads Tail of pancreas Greater omentum Splenorenal ligament Ureter
Ureter
Accessory spleens
- 10% population
- 1 cm size
- locations: hilum of the spleen, tail of the pancreas, along the splenic vessels, in the gastrosplenic ligament, the splenorenal ligament, the walls of the stomach or intestines, the greater omentum, the mesentery, the gonads
A 56 year old man is undergoing an anterior resection for a carcinoma of the rectum. Which of the structures below is least likely to be encountered during the mobilisation of the anterior rectum?
Denonvilliers' fascia Middle sacral artery Bladder Rectovesical pouch Seminal vesicles
Middle sacral artery
With the exception of the middle sacral artery all of the other structures lie anterior to the rectum. They may all be palpated during digital rectal examination.
In relation to the middle cranial fossa, which of the following statements relating to the foramina is incorrect?
The foramen rotundum transmits the maxillary nerve The foramen lacerum is closely related to the internal carotid artery The foramen spinosum lies posterolateral to the foramen ovale The foramen ovale transmits the middle meningeal artery The foramen rotundum lies anteromedial to the foramen ovale
The foramen ovale transmits the middle meningeal artery
The foramen spinosum transmits the middle meningeal artery. The foramen ovale transmits the mandibular nerve. As the foramina weaken the bone, a fracture at this site is not uncommon.
During an operation for varicose veins the surgeons are mobilising the long saphenous vein. Near its point of entry to the femoral vein an artery is injured and bleeding is encountered. From where is the bleeding most likely to originate?
Femoral artery Profunda femoris artery Superficial circumflex iliac artery Superficial epigastric artery Deep external pudendal artery
Deep external pudendal artery
The deep external pudendal artery is a branch of the SFA and it runs medially under the long saphenous vein near its point of union with the femoral vein
A 78 year old man is lifting a heavy object when he feels a pain in his forearm and is unable to continue. He has a swelling over his upper forearm. An MRI scan shows a small cuff of tendon still attached to the radial tuberosity consistent with a recent tear. Which of the following muscles has been injured?
Pronator teres Supinator Aconeus Brachioradialis Biceps brachii
Biceps brachii
Biceps inserts into the radial tuberosity. Distal injuries of this muscle are rare but are reported and are clinically more important than more proximal ruptures.
What is embryological origin of the pulmonary artery?
First pharyngeal arch Second pharyngeal arch Fourth pharyngeal arch Fifth pharyngeal arch Sixth pharyngeal arch
Sixth pharyngeal arch
The proximal part of the sixth right pharyngeal arch gives origin to the right pulmonary artery. The distal part gives origin to the left pulmonary artery and the ductus arteriosus.
A 53 year old lady presents with pain and discomfort in her hand. She works as a typist and notices that the pain is worst when she is working. She also suffers symptoms at night. Her little finger is less affected by the pain. Which of the nerves listed below is most likely to be affected?
Radial Median Ulnar Anterior interosseous nerve Posterior interosseous nerve
Median
The most likely diagnosis here is carpal tunnel syndrome, the median nerve is compressed in the wrist and symptoms usually affect the fingers and wrist either at night or when the hand is being used (e.g. as a typist).
Which of the following muscles lies medial to the long thoracic nerve?
Serratus anterior Latissimus dorsi Coracobrachialis Pectoralis minor None of the above
Serratus anterior
The thebesian veins contribute to the venous drainage of the heart. Into which of the following structures do they primarily drain?
Great cardiac vein Atrium Superior vena cava Oblique vein Small cardiac vein
Atrium
The thebesian veins are numerous small veins running over the surface of the heart they drain into the heart itself. Usually this is to the atrium directly.
Which of the following is not contained within the deep posterior compartment of the lower leg?
Tibialis posterior muscle Posterior tibial artery Tibial nerve Sural nerve Flexor hallucis longus
Sural nerve
The deep posterior compartment lies anterior to soleus. The sural nerve is superficially sited and therefore not contained within it.
The inferior aspect of the vagina drains to which of the following lymph node groups?
Superficial inguinal nodes Internal iliac nodes Para-aortic nodes Obturator nodes Meso-rectal nodes
Superficial inguinal nodes
When performing minor surgery in the scalp, which of the following regions is considered a danger area as regards spread of infection into the CNS?
Aponeurosis epicranialis Skin Pericranium Connective tissue Loose areolar tissue
Loose areolar tissue
This area is most dangerous as infections can spread easily. The emissary veins that drain this area may allow sepsis to spread to the cranial cavity.
