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.
Which of the following structures are at risk of direct injury following a fracture dislocation of the femoral condyles?
Popliteal artery Sciatic nerve Plantaris muscle Tibial artery Tibial nerve
Popliteal artery
The heads of gastrocnemius will contract to pull the fracture segment posteriorly. The popliteal artery lies against the bone and may be damaged or compressed.
A 25 year old man is being catheterised, prior to a surgical procedure. As the catheter enters the prostatic urethra which of the following changes will occur?
Resistance will increase significantly Resistance will increase slightly It will lie horizontally Resistance will decrease It will deviate laterally
Resistance will decrease
The prostatic urethra is much wider than the membranous urethra and therefore resistance will decrease. The prostatic urethra is inclined superiorly.
A 24 year female is admitted to A&E with tingling of her hand after a fall. She is found to have a fracture of the medial epicondyle. What is the most likely nerve lesion?
Ulnar nerve Radial nerve Median nerve Axillary nerve Cutaneous nerve
Ulnar nerve
The radial nerve is located near the lateral epicondyle.
During a gangland gunfight a man is shot in the chest. The bullet passes through the posterior mediastinum (from left to right). Which of the following structures is least likely to be injured
Thoracic duct Oesophagus Vagus nerve Descending thoracic aorta Arch of the azygos vein
Arch of the azygos vein
The arch of the azygos vein lies in the middle mediastinum.
The space between the vocal cords is referred to as which of the following?
Piriform recess Rima vestibuli Vestibule Vallecula Rima glottidis
Rima glottidis
The rima glottidis is the narrowest part of the laryngeal cavity.
At what level does the sciatic nerve usually bifurcate into the tibial and common peroneal nerves?
At the superior aspect of the popliteal fossa At the inferior aspect of the popliteal fossa At the inferior border of gluteus maximus At the inferior border of the piriformis muscle In the pelvis
At the superior aspect of the popliteal fossa
The sciatic nerve passes vertically downwards over the posterior surface of the obturator internus and quadratus femoris to the hamstring compartment of the thigh, here it is crossed posteriorly by the long head of biceps femoris
A 78 year old man develops a carcinoma of the scrotum. To which of the following lymph node groups may the tumour initially metastasise?
Para aortic Obturator Inguinal Meso rectal None of the above
Inguinal
The scrotum is drained by the inguinal nodes.
A 63 year old man is undergoing an upper GI endoscopy for dysphagia. At 33 cm (from the incisors) a malignant looking stricture is encountered. The endoscopist attempts a balloon dilatation.Unfortunately the tumour splits through the oesophageal wall. Into which region will the oesophageal contents now drain?
Superior mediastinum Posterior mediastinum Middle mediastinum Anterior mediastinum Peritoneal cavity
Posterior mediastinum
At this position the oesophagus is still likely to be intrathoracic and located in the posterior mediastinum.
During a tricuspid valve repair the right atrium is opened, following establishment of cardiopulmonary bypass. Which of the following structures do not lie within the right atrium?
Crista terminalis Tricuspid valve Fossa ovalis Trabeculae carnae Musculi pectinati
Trabeculae carnae
The trabeculae carnae are located in the right ventricle.
A 44 year old lady has undergone a mastectomy and axillary node clearance. Post operatively, she notices a patch of anaesthesia of her axillary skin when she applies an underarm deodorant. Which nerve has most likely been affected?
Axillary Intercostobrachial Long thoracic Thoracodorsal Accessory
Intercostobrachial
The intercostobrachial nerves traverse the axilla and innervate the overlying skin
Which of the following is a recognised tributary of the retromandibular vein?
Internal jugular vein External jugular vein Anterior temporal diploic vein Maxillary vein Inferior opthalmic vein
Maxillary vein
The retromandibular vein is formed from the union of the maxillary and superficial temporal veins.
A 32 year old lady is admitted with weakness, visual disturbance and peri orbital pain. On examination, she is noted to have mydriasis and diminished direct response to light shone into the affected eye. The consensual response is preserved when light is shone into the unaffected eye. Which of the cranial nerves listed below is responsible for the diminished direct response?
Abducens Oculomotor Optic Trigeminal Hypoglossal
Optic
The most likely cause for this is an optic neuritis (not really surgical!). Other causes include ischemic optic disease or retinal disease, severe glaucoma causing trauma to optic nerve and direct optic nerve damage (trauma, radiation, tumor).
An 22 year old soldier is shot in the abdomen and amongst his various injuries is a major disruption to the abdominal aorta. There is torrential haemorrhage and the surgeons decide to control the aorta by placement of a vascular clamp immediately inferior to the diaphragm. Which of the following vessels may be injured in this maneouvre?
Inferior phrenic arteries Superior phrenic arteries Splenic artery Renal arteries Superior mesenteric artery
Inferior phrenic arteries
As the first branches of the abdominal aorta the inferior phrenic arteries are at greatest risk.
Which of the following statements relating to the gallbladder is untrue?
The fundus is usually intra peritoneal Arterial supply is from the cystic artery The cystic artery is usually located in Calots triangle Calots triangle may rarely contain an aberrant hepatic artery Cholecystokinin causes relaxation of the gallbladder
Cholecystokinin causes relaxation of the gallbladder
CCK causes gallbladder contraction.
Which of the following nerves is the primary source of innervation to the anterior scrotal skin?
Iliohypogastric nerve Pudendal nerve Ilioinguinal nerve Femoral branch of the genitofemoral nerve Obturator nerve
Ilioinguinal nerve
The pudendal nerve may innervate the posterior skin of the scrotum. The anterior innervation of the scrotum is primarily provided by the ilioinguinal nerve.
The motor nucleus of cranial nerve V supplies all except which of the following muscles?
Masseter Posterior belly of digastric Temporalis Tensor tympani Tensor veli palatini
Posterior belly of digastric
The posterior belly of digastric is supplied by the branchial motor component of the facial nerve.
The transversalis fascia contributes to which of the following?
Pectineal ligament Deep inguinal ring Cremaster muscle and fascia Inguinal ligament External spermatic fascia
Deep inguinal ring
The principal outpouching of the transversalis fascia is the internal spermatic fascia. The mouth of the outpouching is the deep inguinal ring.
A 63 year old man is undergoing a right pneumonectomy for carcinoma of the bronchus. As the surgeons approach the root of the lung, which structure will lie most posteriorly (in the anatomical plane)?
Phrenic nerve Main bronchus Vagus nerve Pulmonary vein Pulmonary artery
Vagus nerve
The vagus nerve is the most posteriorly located structure at the lung root. The phrenic nerve lies most anteriorly.
A 43 year old lady is undergoing an axillary node clearance for breast cancer. The nodal disease is bulky. During clearance of the level 3 nodes there is suddenly brisk haemorrhage. The most likely vessel responsible is:
Thoracoacromial artery Cephalic vein Thoracodorsal trunk Internal mammary artery Posterior circumflex humeral artery
Thoracoacromial artery
The thoracoacromial artery pierces the pectoralis major and gives off branches within this space
A 73 year old lady with long standing atrial fibrillation develops a cold and pulseless white arm. A brachial embolus is suspected and a brachial embolectomy is performed. Which of the following structures is at greatest risk of injury during this procedure?
Radial nerve Cephalic vein Ulnar nerve Median nerve None of the above
Median nerve
The median nerve lies close to the brachial artery in the antecubital fossa.
A 73 year old lady is admitted with right iliac fossa pain. A plain abdominal x-ray is taken and the caecal diameter measured. Which of the following caecal diameters is pathological?
4cm 5cm 6cm 7cm 10cm
10cm
8 cm is still within normal limits. However, caecal diameters of 9 and 10 are pathological and should prompt further investigation.
Which of the following fingers is not a point of attachment for the palmar interossei?
Middle finger Little finger Ring finger Index finger None of the above
Middle finger
The middle finger has no attachment of the palmar interosseous.
A 33 year old man sustains an injury to his forearm and wrist. When examined in clinic he is unable to adduct his thumb. What is the most likely underlying nerve lesion?
Radial nerve Superficial branch of the ulnar nerve Median nerve Posterior interosseous nerve Deep branch of the ulnar nerve
Deep branch of the ulnar nerve
Damage to the deep branch of the ulnar nerve may result in an inability to adduct the thumb.
A 6 year old sustains a supracondylar fracture of the distal humerus. There are concerns that the radial nerve may have been injured. What is the relationship of the radial nerve to the humerus at this point?
Anterolateral Anteromedial Posterolateral Posteromedial Immediately anterior
Anterolateral
The radial nerve lies anterolateral to the humerus in the supracondylar area.
Which of the following muscles is penetrated by the parotid duct?
Medial pterygoid Buccinator Levator anguli oris Temporalis Masseter
Buccinator
The duct crosses the masseter muscle and buccal fat pad and then penetrates the buccinator muscle to enter the oral cavity opposite the second upper molar tooth.
The following are true of the ulnar nerve except:
It innervates the palmar interossei Derived from the medial cord of the brachial plexus Supplies the muscles of the thenar eminence Supplies the medial half of flexor digitorum profundus Passes superficial to the flexor retinaculum
Supplies the muscles of the thenar eminence
The muscles of the thenar eminence are supplied by the median nerve and atrophy of these is a feature of carpal tunnel syndrome
How many valves lie between the superior vena cava and the right atrium?
None One Two Three Four
None
There are no valves which is why it is relatively easy to insert a CVP line from the internal jugular vein into the right atrium.
Which of the following options in relation to the liver is true?
Ligamentum venosum is an anterior relation of the liver The portal triad comprises the hepatic artery, hepatic vein and tributary of the bile duct The liver is completely covered by peritoneum There are no nerves within the porta hepatis The caudate lobe is superior to the porta hepatis
The caudate lobe is superior to the porta hepatis
Ligamentum venosum is posterior to the liver. The portal triad contains the portal vein rather than the hepatic vein. There is the ‘bare area of the liver’ created by a void due to the coronary ligament layers being widely separated. There are sympathetic and parasympathetic nerves in the porta hepatis.
Which of the following structures does not pass anterior to the lateral malleolus?
Anterior tibial artery Extensor digitorum longus Lateral branch of the superficial peroneal nerve Peroneus brevis Peroneus tertius
Peroneus brevis
Peroneus brevis passes posterior to the lateral malleolus. Peroneus tertius is closely related to extensor digitorum and like that muscle, its tendon passes anterior to the lateral malleolus
The following statements regarding the rectus abdominis muscle are true except:
It runs from the symphysis pubis to the xiphoid process Its nerve supply is from the ventral rami of the lower 6 thoracic nerves It has collateral supply from both superior and inferior epigastric vessels It lies in a muscular aponeurosis throughout its length It has a number of tendinous intersections that penetrate through the anterior layer of the muscle
It lies in a muscular aponeurosis throughout its length
The aponeurosis is deficient below the arcuate line.
Which of the following statements relating to sternocleidomastoid is untrue?
The external jugular vein lies posteromedially. It is supplied by the accessory nerve. It has two heads of origin It inserts into the lateral aspect of the mastoid process. It marks the anterior border of the posterior triangle.
The external jugular vein lies posteromedially.
The external jugular vein lies lateral (i.e. superficial) to the sternocleidomastoid.
