EMRCS ANATOMY 3 Flashcards
Which of the following statements relating to the root of the neck is false?
The lung projects into the neck beyond the first rib and is constrained by Sibson's fascia The subclavian artery arches over the first rib anterior to scalenus anterior The trunks of the brachial plexus lie posterior to the subclavian artery on the first rib The roots and trunks of the Brachial plexus lie between scalenus anterior and scalenus medius muscles The thyrocervical trunk is a branch of the subclavian artery
The subclavian artery lies posterior to scalenus anterior, the vein lies in front. Sibson’s fascia is another name for the suprapleural membrane.
A patient presents to the clinic following a surgical procedure. She complains that she is unable to shrug her shoulder. What is the most likely underlying nerve injury?
Accessory nerve Cervical plexus Ansa cervicalis Long thoracic nerve Axillary nerve
The accessory nerve may be injured in operations in the posterior triangle. Injury will affect trapezius.
A 53 year old man is to undergo a thyroidectomy. Which nerve is at greatest risk?
Hypoglossal Recurrent laryngeal Ansa cervicalis Accessory Marginal mandibular
Recurrent laryngeal nerve injury may complicate thyroid surgery in up to 1- 2% of cases.
The cords of the brachial plexus are most closely related to which of the following vessels?
Subclavian artery Axillary artery Axillary vein Subclavian vein Brachial artery
The trunks are related to the subclavian artery superiorly. The cords of the plexus surround the axillary artery, they are named according to their positions relative to this structure.
Which of the following are not generally supplied by the right coronary artery?
The sino atrial node The circumflex artery The atrioventricular node Most of the right ventricle The right atrium
The circumflex artery is generally a branch of the left coronary artery.
A 44 year old man has a malignant melanoma and is undergoing a block dissection of the groin. The femoral triangle is being explored for intra operative bleeding. Which of the following forms the medial border of the femoral triangle?
Femoral artery Biceps femoris Adductor longus Sartorius Adductor magnus
Adductor longus forms the medial boundary of the femoral triangle
The foramen marking the termination of the adductor canal is located in which of the following?
Adductor longus Adductor magnus Adductor brevis Sartorius Semimembranosus
The foramen marking the distal limit of the adductor canal is contained within adductor magnus. The vessel passes through this region to enter the popliteal fossa.
Which of the following is the first vessel to branch from the external carotid artery?
Superior thyroid artery Inferior thyroid artery Lingual artery Facial artery Occipital artery
The first branch of the external carotid artery is the superior thyroid artery. The inferior thyroid artery is derived from the thyrocervical trunk
Mnemonic
(Order in which they branch off)Some (sup thyroid)Attendings (Ascending Pharyngeal)Like (Lingual)Freaking (Facial)Out (Occipital)Potential (Post auricular)Medical (Maxillary)Students (Sup temporal
A motorcyclist is injured in a road traffic accident and is not wearing a helmet. He suffers a severe closed head injury and develops raised intracranial pressure. The first cranial nerve to be affected by this process is likely to be:
Oculomotor Hypoglossal Motor branch of the trigeminal Abducens Sensory branch of the trigeminal
The abducens nerve (CN VI) has a long intra cranial course and is thus susceptible to raised intra cranial pressure. It also passes over the petrous temporal bone and 6th nerve palsies are also seen in mastoiditis.
A 32 year old man is undergoing a splenectomy. Division of which of the following will be necessary during the procedure?
Left crus of diaphragm Short gastric vessels Gerotas fascia Splenic flexure of colon Marginal artery
During a splenectomy the short gastric vessels which lie within the gastrosplenic ligament will need to be divided. The splenic flexure of the colon may need to be mobilised. However, it will almost never need to be divided, as this is watershed area that would necessitate a formal colonic resection in the event of division.
Which structure separates the cephalic vein and the brachial artery in the antecubital fossa?
Brachioradialis muscle Biceps muscle Origin of flexor digitorum profundus muscle Pronator quadratus muscle Origin of flexor digitorum superficialis muscle
Biceps muscle
A 23 year old rugby player sustains a Smiths Fracture. On examination, opposition of the thumb is markedly weakened. Which of the following nerves is least likely to be working normally?
Ulnar Median Radial Musculocutaneous Palmar cutaneous
This high velocity injury can often produce significant angulation and displacement. Both of these may impair the function of the median nerve with loss of function of the muscles of the thenar eminence.
A 24 year old motor cyclist is involved in a road traffic accident. He suffers a tibial fracture which is treated with an intra medullary nail. Post operatively he develops a compartment syndrome. Surgical decompression of the anterior compartment will relieve pressure on all of the following muscles except?
Peroneus brevis Peroneus tertius Extensor digitorum longus Tibialis anterior None of the above
The anterior compartment contains: Tibialis anterior Extensor digitorum longus Peroneus tertius Extensor hallucis longus Anterior tibial artery All the muscles are innervated by the deep peroneal nerve.
A 43 year old lady underwent an attempted placement of a central line into the internal jugular vein. Unfortunately, the doctor damaged the carotid artery and this necessitated surgical exploration. As the surgeons incise the carotid sheath a nerve is identified lying between the internal jugular vein and the carotid artery. Which of the following is this nerve most likely to be?
Glossopharyngeal nerve Hypoglossal nerve Superior laryngeal nerve Recurrent laryngeal nerve Vagus
The vagus lies in the carotid sheath. The hypoglossal nerve crosses the sheath, but does not lie within it
A patient has a chest drain insertion. There is fresh blood at the chest drain insertion area. Which vessel has been damaged?
Pericardiophrenic artery Intercostal vein Right ventricle Vagus artery Intercostal artery
Intercostal artery
The intercostal vein is more superior than the artery and is thus slightly less susceptible to injury.
Two teenagers are playing with an airgun when one accidentally shoots his friend in the abdomen. He is brought to the emergency department. On examination there is a bullet entry point immediately to the right of the rectus sheath at the level of the 1st lumbar vertebra. Which of the following structures is most likely to be injured by the bullet?
Head of pancreas Right ureter Right adrenal gland Fundus of the gallbladder Gastric antrum
The fundus of the gallbladder lies at this level and is the most superficially located structure.
Which of the following muscles inserts onto the lesser tuberostiy of the the humerus?
Subscapularis Deltoid Supraspinatus Teres minor Infraspinatus
With the exception of subscapularis which inserts into the lesser tuberosity, the muscles of the rotator cuff insert into the greater tuberosity.
Which of the following nerves is not contained within the posterior triangle of the neck?
Accessory nerve Phrenic nerve Greater auricular nerve Ansa cervicalis Lesser occiptal nerve
Ansa cervicalis is a content of the anterior triangle of the neck.
A 42 year old lady is reviewed in the outpatient clinic following a routine surgical procedure. She complains of diminished sensation at the dorso-lateral aspect of her foot. Which of the following nerves is most likely to be affected?
Sural Superficial peroneal Deep peroneal Medial plantar Lateral plantar
The sural nerve supplies the lateral aspect of the foot. It runs alongside the short saphenous vein and may be injured in short saphenous vein surgery.
Which of the following anatomical planes separates the prostate from the rectum?
Sibsons fascia Denonvilliers fascia Levator ani muscle Waldeyers fascia None of the above
The Denonvilliers fascia separates the rectum from the prostate. Waldeyers fascia separates the rectum from the sacrum
A 56 year old lady is undergoing an adrenalectomy for Conns syndrome. During the operation the surgeon damages the middle adrenal artery and haemorrhage ensues. From which of the following structures does this vessel originate?
Aorta Renal artery Splenic artery Coeliac axis Superior mesenteric artery
The middle adrenal artery is usually a branch of the aorta, the lower adrenal artery typically arises from the renal vessels.
A 72 year old man is undergoing a left pneumonectomy for carcinoma of the bronchus. As the surgeons approach the root of the lung, which structure will lie most anteriorly (in the anatomical plane)?
Vagus nerve Phrenic nerve Bronchus Pulmonary vein Pulmonary artery
The phrenic nerve is the most anteriorly located structure in the lung root. The vagus nerve lies most posteriorly.
A 73 year old lady suffers a fracture at the surgical neck of the humerus. The decision is made to operate. There are difficulties in reducing the fracture and a vessel lying posterior to the surgical neck is injured. Which of the following is this vessel most likely to be?
Axillary artery Brachial artery Thoracoacromial artery Transverse scapular artery Posterior circumflex humeral artery
The circumflex humeral arteries lie at the surgical neck and in this scenario the posterior circumflex is likely to be injured. The thoracoacromial and transverse scapular arteries lie more superomedially. The posterior circumflex humeral artery is a branch of the axillary artery.
Which of the structures listed below lies posterior to the carotid sheath at the level of the 6th cervical vertebra?
Hypoglossal nerve Vagus nerve Cervical sympathetic chain Ansa cervicalis Glossopharyngeal nerve
The carotid sheath is crossed anteriorly by the hypoglossal nerves and the ansa cervicalis. The vagus lies within it. The cervical sympathetic chain lies posteriorly between the sheath and the prevertebral fascia.
A sprinter attends A&E with severe leg pain. He had forgotten to warm up and ran a 100m sprint race. Towards the end of the race he experienced pain in the posterior aspect of his thigh. The pain worsens, localising to the lateral aspect of the knee. The sprinter is unable to flex the knee. What structure has been injured?
Anterior cruciate ligament Posterior cruciate ligament Semimembranosus tendon Semitendinosus tendon Biceps femoris tendon
The biceps femoris is commonly injured in sports that require explosive bending of the knee as seen in sprinting, especially if the athlete has not warmed up first. Avulsion most commonly occurs where the long head attaches to the ischial tuberosity. Injuries to biceps femoris are more common than to the other hamstrings.
A 64 year old man has a suspected lymphoma and lymph node biopsy from the posterolateral aspect of the right neck is planned. Which of the nerves listed is at greatest risk?
Accessory Long thoracic External laryngeal Facial Vagus
The accessory nerve has a superficial course and is easily injured. It lies under platysma and may be divided during the early part of the procedure
A 24 year old man falls and lands astride a manhole cover. He suffers from an injury to the anterior bulbar urethra. Where will the extravasated urine tend to collect?
Lesser pelvis Connective tissue of the scrotum Deep perineal space Ischiorectal fossa Posterior abdominal wall
Connective tissue of the scrotum
This portion of the urethra is contained between the perineal membrane and the membranous layer of the superficial fascia. As these are densely adherent to the ischiopubic rami, extravasated urine cannot pass posteriorly because the 2 layers are continuous around the superficial transverse perineal muscles.
A 29 year old woman has had a Pfannenstiel incision. She has pain over the inguinal ligament which radiates to the lower abdomen. There is tenderness when the inguinal canal is compressed. Which of the following is most likely to have been affected?
Genitofemoral nerve Ilioinguinal nerve Lateral cutaneous nerve of the thigh Iliohypogastric nerve Saphenous nerve
Ilioinguinal nerve
The following operations and their associated nerve lesions are listed here:
Posterior triangle lymph node biopsy and accessory nerve lesion.
Lloyd Davies stirrups and common peroneal nerve.
Thyroidectomy and laryngeal nerve.
Anterior resection of rectum and hypogastric autonomic nerves.
Axillary node clearance; long thoracic nerve, thoracodorsal nerve and intercostobrachial nerve.
Inguinal hernia surgery and ilioinguinal nerve.
Varicose vein surgery- sural and saphenous nerves.
Posterior approach to the hip and sciatic nerve.
Carotid endarterectomy and hypoglossal nerve.
A 73 year old man presents with symptoms of mesenteric ischaemia. As part of his diagnostic work up a diagnostic angiogram is performed .The radiologist is attempting to cannulate the coeliac axis from the aorta. At which of the following vertebral levels does this is usually originate?
T10 L2 L3 T8 T12
The coeliac axis branches off the aorta at T12.
Coeliac trunk branches:
Left Hand Side (LHS)
Left gastric
Hepatic
Splenic
A 43 year old man is diagnosed as having a malignancy of the right adrenal gland. The decision is made to resect this via an open anterior approach. Which of the following will be most useful during the surgery?
Division of the coronary ligaments of the liver Mobilisation of the colonic hepatic flexure Division of the right renal vein Division of the ligament of Trietz Division of the right colic artery
Mobilisation of the hepatic flexure and right colon are standard steps in open adrenal surgery from an anterior approach. Mobilisation of the liver is seldom required.
The right and left pulmonary arteries are derived from which of the following embryological aortic arches?
Fifth Second Sixth Fourth Third
Pulmonary vessels develop from the sixth arch
A 45 year old man presents with a lipoma located posterior to the posterior border of the sternocleidomastoid muscle, approximately 4cm superior to the middle third of the clavicle. During surgical excision of the lesion troublesome bleeding is encountered. Which of the following is the most likely source?
Internal jugular vein External jugular vein Common carotid artery Vertebral artery Second part of the subclavian artery
The external jugular vein runs obliquely in the superficial fascia of the posterior triangle. It drains into the subclavian vein. During surgical exploration of this area the external jugular vein may be injured and troublesome bleeding may result. The internal jugular vein and carotid arteries are located in the anterior triangle. The third, and not the second, part of the subclavian artery is also a content of the posterior triangle
The sciatic nerve lies deep to the following structures except:
Gluteus maximus The femoral cutaneous nerve Long head of biceps femoris Gluteus medius Branch of the inferior gluteal artery
The gluteus medius does not extend around to the sciatic nerve.
Which of the following upper limb muscles is not innervated by the radial nerve?
Extensor carpi ulnaris Abductor digiti minimi Anconeus Supinator Brachioradialis
Abductor digiti minimi is innervated by the ulnar nerve.
Which of the following forms the floor of the anatomical snuffbox?
Radial artery Cephalic vein Extensor pollicis brevis Scaphoid bone Cutaneous branch of the radial nerve
The scaphoid bone forms the floor of the anatomical snuffbox. The cutaneous branch of the radial nerve is much more superficially and proximally located.
During a liver resection a surgeon performs a pringles manoeuvre to control bleeding. Which of the following structures will lie posterior to the epiploic foramen at this level?
Hepatic artery Cystic duct Greater omentum Superior mesenteric artery Inferior vena cava
The epiploic foramen has the following boundaries:
Anteriorly (in the free edge of the lesser omentum): Bile duct to the right, portal vein behind and hepatic artery to the left.
Posteriorly Inferior vena cava
Inferiorly 1st part of the duodenum
Superiorly Caudate process of the liver
A 72 year old lady is suspected of having a femoral hernia. At which of the following sites is it most likely to be identifiable clinically?
Mid inguinal point Above and medial to the pubic tubercle Below and lateral to the pubic tubercle Mid point of the inguinal ligament 3 cm superomedially to the superficial inguinal ring
Femoral hernias exit the femoral canal below and lateral to the pubic tubercle. Femoral hernia occur mainly in women due to their difference in pelvic anatomy. They are at high risk of strangulation and therefore should be repaired.
Which nerve supplies the skin at the medial aspect of the palm?
Ulnar Radial Median Musculocutaneous Anterior interosseous
Medial = Ulnar
Which muscle is responsible for causing flexion of the distal interphalangeal joint of the ring finger?
Flexor digitorum superficialis Lumbricals Palmar interossei Flexor digitorum profundus Flexor digiti minimi brevis
Flexor digitorum superficialis and flexor digitorum profundus are responsible for causing flexion. The superficialis tendons insert on the bases of the middle phalanges; the profundus tendons insert on the bases of the distal phalanges. Both tendons flex the wrist, MCP and PIP joints; however, only the profundus tendons flex the DIP joints.
A 34 year old lady undergoes a thyroidectomy for Graves disease. Post operatively she develops a tense haematoma in the neck. In which of the following fascial planes will it be contained?
Gerotas fascia Waldeyers fascia Pretracheal fascia Sibsons fascia Clavipectoral fascia
The pretracheal fascia encloses the thyroid and is unyielding. Therefore tense haematomas can develop.
A 32 year old lady complains of carpal tunnel syndrome. The carpal tunnel is explored surgically. Which of the following structures will lie in closest proximity to the hamate bone within the carpal tunnel?
The tendon of abductor pollicis longus The tendons of flexor digitorum profundus The tendons of flexor carpi radialis longus Median nerve Radial artery
The tendon of flexor digitorum profundus lies deepest in the tunnel and will thus lie nearest to the hamate bone.
A 45 year old man sustains a significant head injury and a craniotomy is performed. The sigmoid sinus is bleeding profusely, into which of the following structures does it drain?
Internal jugular vein Straight sinus Petrosal sinus Inferior sagittal sinus External jugular vein
The sigmoid sinus is joined by the inferior petrosal sinus to drain into the internal jugular vein
Which nerve supplies the interossei of the fourth finger?
Radial Median Superficial ulnar Deep ulnar Posterior interosseous
Deep ulnar
In which of the following cranial bones does the foramen spinosum lie?
Sphenoid bone Frontal bone Temporal bone Occipital bone Parietal bone
The foramen spinosum (which transmits the middle meningeal artery and vein) lies in the sphenoid bone.
Which of the following is not considered a major branch of the descending thoracic aorta?
Bronchial artery Mediastinal artery Inferior thyroid artery Posterior intercostal artery Oesophageal artery
The inferior thyroid artery is usually derived from the thyrocervical trunk, a branch of the subclavian artery.
An 18 year old lady with troublesome hyperhidrosis of the hands and arms is due to undergo a sympathectomy to treat the condition. Which of the following should the surgeons divide to most effectively treat her condition?
Sympathetic ganglia at T1, T2 and T3 Sympathetic ganglia at T2 and T3 Sympathetic ganglia at T1 and T2 Stellate ganglion Superior cervical ganglion
To treat hyperhidrosis the sympathetic ganglia at T2 and T3 should be divided. Dividing the other structures listed would either carry a risk of Horners syndrome or be ineffective.
A 44 year old lady is recovering following a transphenoidal hypophysectomy. Unfortunately there is a post operative haemorrhage. Which of the following features is most likely to occur initially?
Cavernous sinus thrombosis Abducens nerve palsy Bi-temporal hemianopia Inferior homonymous hemianopia Central retinal vein occlusion
The pituitary is covered by a sheath of dura and an expanding haematoma at this site may compress the optic chiasm in the same manner as an expanding pituitary tumour.
During a right hemicolectomy the caecum is mobilised. As the bowel is retracted medially a vessel is injured, posterior to the colon. Which of the following is the most likely vessel?
Right colic artery Inferior vena cava Aorta External iliac artery Gonadal vessels
The key in this question is that its during the caecal mobilization. The gonadal vessels and ureter are important posterior relations that are at risk during a right hemicolectomy. During latter stages of the procedure, the ileocolic artery and vein are traced along the anterior aspect of the duodenum. At this point it is possible to injure these, the superior mesenteric vein or the middle colic vein, injury to any of these can result in torrential bleeding that is very difficult to control.
A 53 year old man with a carcinoma of the lower third of the oesophagus is undergoing an oesophagogastrectomy. As the surgeons mobilise the lower part of the oesophagus, where are they most likely to encounter the thoracic duct?
Anterior to the oesophagus On the left side of the oesophagus On the right side of the oesophagus Immediately anterior to the azygos vein Posterior to the oesophagus
The thoracic duct lies posterior to the oesophagus and passes to the left at the level of the Angle of Louis. It enters the thorax at T12 together with the aorta.
Which of the following represents the root values of the sciatic nerve?
L4 to S3 L1 to L4 L3 to S1 S1 to S4 L5 to S1
The sciatic nerve most commonly arises from L4 to S3.
