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.
