EMRCS ANATOMY 4 Flashcards
An 83 year old lady presents with a femoral hernia and undergoes a femoral hernia repair. Which of the following forms the posterior wall of the femoral canal?
Pectineal ligament Lacunar ligament Inguinal ligament Adductor longus Sartorius
Borders of the femoral canal Laterally Femoral vein Medially Lacunar ligament Anteriorly Inguinal ligament Posteriorly Pectineal ligament
A 45 year man presents with hand weakness. He is given a piece of paper to hold between his thumb and index finger. When the paper is pulled, the patient has difficulty maintaining a grip. Grip pressure is maintained by flexing the thumb at the interphalangeal joint. What is the most likely nerve lesion?
Posterior interosseous nerve Deep branch of ulnar nerve Anterior interosseous nerve Superficial branch of the ulnar nerve Radial nerve
Anterior interosseous nerve
This is a description of Froment’s sign, which tests for ulnar nerve palsy. It mainly tests for the function of adductor pollicis. This is supplied by the deep branch of the ulnar nerve. Remember the anterior interosseous branch (of the median nerve), which innervates the flexor pollicis longus (hence causing flexion of the thumb IP joint), branches off more proximally to the wrist.
Which of the following cranial foramina pairings are incorrect?
Carotid canal and internal carotid artery. Foramen ovale and mandibular nerve. Optic canal and ophthalmic artery. Optic canal and ophthalmic nerve. Foramen rotundum and maxillary nerve.
The optic canal transmits the optic nerve. The ophthalmic nerve traverses the superior orbital fissure.
A 22 year old man is involved in a fight and sustains a stab wound in his upper forearm. On examination there is a small, but deep laceration. There is an obvious loss of pincer movement involving the thumb and index finger with minimal loss of sensation. The most likely nerve injury is to the:
Ulnar nerve Radial nerve Anterior interosseous nerve Axillary nerve Median nerve
The anterior interosseous nerve is a motor branch of the median nerve just below the elbow. When damaged it classically causes:
Pain in the forearm
Loss of pincer movement of the thumb and index finger (innervates the long flexor muscles of flexor pollicis longus & flexor digitorum profundus of the index and middle finger)
Minimal loss of sensation due to lack of a cutaneous branch
A 66 year old man is undergoing a left nephro-ureterectomy. The surgeons remove the ureter, which of the following is responsible for the blood supply to the proximal ureter?
Branches of the renal artery External iliac artery Internal iliac artery Direct branches from the aorta Common iliac artery
The proximal ureter is supplied by branches from the renal artery
Which of the following structures does not pass behind the lateral malleolus?
Peroneus brevis tendon Sural nerve Short saphenous vein Peroneus longus tendon Tibialis anterior tendon
Tibialis anterior tendon passes anterior to the medial malleolus
A 63 year old man is admitted with severe headache, nausea and recent epileptic fit. Fundoscopy shows papilloedema. He is also noted to have diplopia. Which of the cranial nerves listed accounts for the latter?
Abducens Optic Oculomotor Facial Trigeminal
The long intracranial course of this nerve makes it susceptible to damage early in the course of raised ICP.
A 78 year old man presents with symptoms consistent with intermittent claudication. To assess the severity of his disease you decide to measure his ankle brachial pressure index. To do this you will identify the dorsalis pedis artery. Which of the following statements relating to this vessel is false?
It originates from the peroneal artery It is crossed by the tendon of extensor hallucis brevis Two veins are usually closely related to it It passes under the inferior extensor retinaculum The tendon of extensor digitorum longus lies lateral to it
The dorsalis pedis artery is a direct continuation of the anterior tibial artery.
Which of the following is not a content of the anterior triangle of the neck?
Vagus nerve Submandibular gland Phrenic nerve Internal jugular vein Hypoglossal nerve
The phrenic nerve is a content of the posterior triangle. The anterior triangle contains the carotid sheath and its contents.
A 32 year old attends neurology clinic complaining of tingling in his hand. He has radial deviation of his wrist and there is mild clawing of his fingers, with the 4th and 5th digits being relatively spared. What is the most likely lesion?
Ulnar nerve damage at the wrist Ulnar nerve damage at the elbow Radial nerve damage at the elbow Median nerve damage at the wrist Median nerve damage at the elbow
Ulnar nerve damage at the elbow
The ulnar paradox- the higher the lesion, the less the clawing of the fingers seen clinically.
At the elbow the ulnar nerve lesion affects the flexor carpi ulnaris and flexor digitorum profundus.
A 22 year old man is undergoing an endotracheal intubation. Which of the following vertebral levels is consistent with the origin of the trachea?
C2 T1 C6 C4 C3
The trachea commences at C6. It terminates at the level of T5 (or T6 in tall subjects in deep inspiration).
A young child undergoes a difficult craniotomy for fulminant mastoiditis and associated abscess. During the procedure the trigeminal nerve is severely damaged within Meckels cave. Which deficit is least likely to be present?
Anaesthesia over the ipsilateral anterior aspect of the scalp Loss of the corneal reflex Weakness of the ipsilateral masseter muscle Anaesthesia of the anterior aspect of the lip Anaesthesia over the entire ipsilateral side of the face
The angle of the jaw is not innervated by sensory fibres of the trigeminal nerve and is spared in this type of injury.
Remember the trigeminal nerve provides motor innervation to the muscles of mastication. The close proximity of the site of injury to the motor fibres is likely to result in at least some compromise of motor muscle function.
Which of the following is not a branch of the external carotid artery?
Facial artery Lingual artery Superior thyroid artery Mandibular artery Maxillary artery
External carotid artery branches mnemonic:
Mandibular artery
‘Some Angry Lady Figured Out PMS’
Superior thyroid (superior laryngeal artery branch) Ascending pharyngeal Lingual Facial (tonsillar and labial artery) Occipital Posterior auricular Maxillary (inferior alveolar artery, middle meningeal artery) Superficial temporal
A 23 year old man is stabbed in the groin, several structures are injured and the adductor longus muscle has been lacerated. Which of the following nerves is responsible for the innervation of adductor longus?
Femoral nerve Obturator nerve Sciatic nerve Common peroneal nerve Ilioinguinal nerve
The adductors are innervated by the obturator nerve
Which of the following statements relating to the basilar artery and its branches is false?
The superior cerebellar artery may be decompressed to treat trigeminal neuralgia Occlusion of the posterior cerebral artery causes contralateral loss of the visual field The oculomotor nerve lies between the superior cerebellar and posterior cerebral arteries The posterior inferior cerebellar artery is the largest of the cerebellar arteries arising from the basilar artery The labyrinthine branch is accompanied by the facial nerve
The posterior inferior cerebellar artery is the largest of the cerebellar arteries arising from the vertebral artery. The labyrinthine artery is long and slender and may arise from the lower part of the basilar artery. It accompanies the facial and vestibulocochlear nerves into the internal auditory meatus. The posterior cerebral artery is often larger than the superior cerebellar artery and it is separated from the vessel, near it’s origin, by the oculomotor nerve. Arterial decompression is a well established therapy for trigeminal neuralgia.
Which of the following muscles does not recieve any innervation from the sciatic nerve?
Semimembranosus Quadriceps femoris Biceps femoris Semitendinosus Adductor magnus
The sciatic nerve is traditionally viewed as being a nerve of the posterior compartment. It is known to contribute to the innervation of adductor magnus (although the main innervation to this muscle is from the obturator nerve). The quadriceps femoris is nearly always innervated by the femoral nerve.
A 23 year old man is involved in a fight and is stabbed in his upper arm. The ulnar nerve is transected. Which of the following muscles will not demonstrate compromised function as a result?
Flexor carpi ulnaris Medial half of flexor digitorum profundus Palmaris brevis Hypothenar muscles Pronator teres
Pronator teres is innervated by the median nerve. Palmaris brevis is innervated by the ulnar nerve
Which of the structures listed below overlies the cephalic vein?
Extensor retinaculum Bicipital aponeurosis Biceps muscle Antebrachial fascia None of the above
None of the above
The cephalic vein is superficially located in the upper limb and overlies most the fascial planes. It pierces the coracoid membrane (continuation of the clavipectoral fascia) to terminate in the axillary vein. It lies anterolaterally to biceps.
Which of the following pairings are incorrect?
Aortic bifurcation and L4 Transpyloric plane and L1 Termination of dural sac and L4 Oesophageal passage through diaphragm and T10 Transition between pharynx and oesophagus at C6
Dural sac terminates at S2, which is why it is safe to undertake an LP at L4/5 levels. The spinal cord itself terminates at L1.
A 22 year old man is involved in a fight. He sustains a laceration to the posterior aspect of his wrist. In the emergency department the wound is explored and the laceration is found to be transversely orientated and overlies the region of the extensor retinaculum, which is intact. Which of the following structures is least likely to be injured in this scenario?
Dorsal cutaneous branch of the ulnar nerve Tendon of extensor indicis Basilic vein Superficial branch of the radial nerve Cephalic vein
Tendon of extensor indicis
The extensor retinaculum attaches to the radius proximal to the styloid, thereafter it runs obliquely and distally to wind around the ulnar styloid (but does not attach to it). The extensor tendons lie deep to the extensor retinaculum and would therefore be less susceptible to injury than the superficial structures.
Which of the following is not a content of the porta hepatis?
Portal vein Hepatic artery Cystic duct Lymph nodes None of the above
The cystic duct lies outside the porta hepatis and is an important landmark in laparoscopic cholecystectomy. The structures in the porta hepatis are:
Portal vein
Hepatic artery
Common hepatic duct
These structures divide immediately after or within the porta hepatis to supply the functional left and right lobes of the liver.
The porta hepatis is also surrounded by lymph nodes, that may enlarge to produce obstructive jaundice and parasympathetic nervous fibres that travel along vessels to enter the liver
Which of the following structures is not closely related to the carotid sheath?
Sternothyroid muscle Sternohyoid muscle Hypoglossal nerve Superior belly of omohyoid muscle Anterior belly of digastric muscle
At its lower end the carotid sheath is related to sternohyoid and sternothyroid. Opposite the cricoid cartilage the sheath is crossed by the superior belly of omohyoid. Above this level the sheath is covered by the sternocleidomastoid muscle. Above the level of the hyoid the vessels pass deep to the posterior belly of digastric and stylohyoid. Opposite the hyoid bone the sheath is crossed obliquely by the hypoglossal nerve.
A 21 year old develops tonsillitis. He is in considerable pain. Which of the following nerves is responsible for the sensory innervation of the tonsillar fossa?
Facial nerve Trigeminal nerve Glossopharyngeal nerve Hypoglossal nerve Vagus
The glossopharyngeal nerve is the main sensory nerve for the tonsillar fossa. A lesser contribution is made by the lesser palatine nerve. Because of this otalgia may occur following tonsillectomy.
A man has an incision sited that runs 8cm from the deltopectoral groove to the midline of the chest. Which of the following is not at risk of injury?
Cephalic vein Shoulder joint capsule Axillary artery Pectoralis major Trunk of the brachial plexus
This region will typically lie medial to the joint capsule
A surgeon is due to perform a laparotomy for perforated duodenal ulcer. An upper midline incision is to be performed. Which of the following structures is the incision most likely to divide?
Rectus abdominis muscle External oblique muscle Linea alba Internal oblique muscle None of the above
Upper midline abdominal incisions will involve the division of the linea alba. Division of muscles will not usually improve access in this approach and they would not be routinely encountered during this incision
A 59 year old man is undergoing an extended right hemicolectomy for a carcinoma of the splenic flexure of the colon. The surgeons divide the middle colic vein close to its origin. Into which of the following structures does this vessel primarily drain?
Superior mesenteric vein Portal vein Inferior mesenteric vein Inferior vena cava Ileocolic vein
The middle colonic vein drains into the SMV, if avulsed during mobilisation then dramatic haemorrhage can occur and be difficult to control.
What is the lymphatic drainage of the female urethra?
Superficial inguinal nodes Deep inguinal nodes Internal iliac nodes External iliac nodes Para-aortic nodes
The entire female urethra drains to the internal iliac nodes.
A 23 year old man is stabbed in the chest approximately 10cm below the right nipple. In the emergency department a abdominal ultrasound scan shows a large amount of intraperitoneal blood. Which of the following statements relating to the likely site of injury is untrue?
Part of its posterior surface is devoid of peritoneum. The quadrate lobe is contained within the functional right lobe. Its nerve supply is from the coeliac plexus. The hepatic flexure of the colon lies posterio-inferiorly. The right kidney is closely related posteriorly.
The right lobe of the liver is the most likely site of injury. Therefore the answer is B as the quadrate lobe is functionally part of the left lobe of the liver. The liver is largely covered in peritoneum. Posteriorly there is an area devoid of peritoneum (the bare area of the liver). The right lobe of the liver has the largest bare area (and is larger than the left lobe).
A 22 year old man is involved in a fight and sustains a skull fracture with an injury to the middle meningeal artery. A craniotomy is performed, and with considerable difficulty the haemorrhage from the middle meningeal artery is controlled by ligating it close to its origin. What is the most likely sensory impairment that the patient may notice post operatively?
Parasthesia of the ipsilateral external ear Loss of taste sensation from the anterior two thirds of the tongue Parasthesia overlying the angle of the jaw Loss of sensation from the ipsilateral side of the tongue Loss of taste from the posterior two thirds of the tongue
The auriculotemporal nerve is closely related to the middle meningeal artery and may be damaged in this scenario. The nerve supplied sensation to the external ear and outermost part of the tympanic membrane. The angle of the jaw is innervated by C2,3 roots and would not be affected. The posterior third of the tongue is supplied by the glossopharyngeal nerve.
Which of the following nerves does not contribute to the innervation of the elbow joint?
Median Musculocutaneous Radial Posterior interosseous Ulnar
The posterior interosseous nerve does not innervate the elbow joint.
A 72 year old man presents with haemoptysis and undergoes a bronchoscopy. The carina is noted to be widened. At which level does the trachea bifurcate?
T3 T5 T7 T2 T8
The trachea bifurcates at the level of the fifth thoracic vertebra. Or the sixth in tall subjects.
A 23 year old man is injured during a game of rugby. He suffers a fracture of the distal third of his clavicle, it is a compound fracture and there is evidence of arterial haemorrhage. Which of the following vessels is most likely to be encountered first during subsequent surgical exploration?
Posterior circumflex humeral artery Axillary artery Thoracoacromial artery Sub scapular artery Lateral thoracic artery
Thoracoacromial artery
The thoracoacromial artery arises from the second part of the axillary artery. It is a short, wide trunk, which pierces the clavipectoral fascia, and ends, deep to pectoralis major by dividing into four branches.
The following are true of the femoral nerve, except:
It is derived from L2, L3 and L4 nerve roots It supplies sartorius It supplies quadriceps femoris It gives cutaneous innervations via the saphenous nerve It supplies adductor longus
Adductor longus is supplied by the obturator nerve.
Where is the vomiting centre located?
Medulla oblongata Substantia nigra Antrum of stomach Pons Midbrain
The vomiting centre is in part of the medulla oblongata and is triggered by receptors in several locations:
Labyrinthine receptors of ear (motion sickness)
Over distention receptors of duodenum and stomach
Trigger zone of CNS - many drugs (e.g., opiates) act here
Touch receptors in throat
Which of the following nerves conveys sensory information from the laryngeal mucosa?
Glossopharyngeal Laryngeal branches of the vagus Ansa cervicalis Laryngeal branches of the trigeminal None of the above
The laryngeal branches of the vagus supply sensory information from the larynx.
Which of the following nerves passes through the greater sciatic foramen and innervates the perineum?
Pudendal Sciatic Superior gluteal Inferior gluteal Posterior cutaneous nerve of the thigh
The pudendal nerve innervates the perineum. It passes between piriformis and coccygeus medial to the sciatic nerve.
3 divisions of the pudendal nerve:
Rectal nerve
Perineal nerve
Dorsal nerve of penis/ clitoris
All these pass through the greater sciatic foramen.
Which of the following is true in relation to the sartorius muscle?
Innervated by the deep branch of the femoral nerve Inserts at the fibula It is the shortest muscle in the body Forms the Pes anserinus with Gracilis and semitendinous muscle Causes extension of the knee
It is innervated by the superficial branch of the femoral nerve. It is a component of the pes anserinus.
A 38 year old man falls onto an outstretched hand. Following the accident he is examined in the emergency department. On palpating his anatomical snuffbox there is tenderness noted in the base. What is the most likely injury in this scenario?
Rupture of the tendon of flexor pollicis Scaphoid fracture Distal radius fracture Rupture of flexor carpi ulnaris tendon None of the above
A fall onto an outstretched hand is a common mechanism of injury for a scaphoid fracture. This should be suspected clinically if there is tenderness in the base of the anatomical snuffbox. A tendon rupture would not result in bony tenderness.
A 25 year old man sustains a severe middle cranial fossa basal skull fracture. Once he has recovered it is noticed that he has impaired tear secretion. This is most likely to be the result of damage to which of the following?
Stellate ganglion Ciliary ganglion Otic ganglion Trigeminal nerve Greater petrosal nerve
The greater petrosal nerve may be injured and carries fibres for lacrimation
Which of the following structures passes through the quadrangular space near the humeral head?
Axillary artery Radial nerve Axillary nerve Median nerve Transverse scapular artery
The quadrangular space is bordered by the humerus laterally, subscapularis superiorly, teres major inferiorly and the long head of triceps medially. It lies lateral to the triangular space. It transmits the axillary nerve and posterior circumflex humeral artery.
Which of the following pairings of foramina and their contents is not correct?
Superior orbital fissure and the oculomotor nerve Foramina rotundum and the maxillary nerve Jugular foramen and the hypoglossal nerve Foramina spinosum and the middle meningeal artery Carotid canal and the internal carotid artery
The hypoglossal nerve passes through the hypoglossal canal.
A 55 year old man with carcinoma of the larynx is undergoing a difficult laryngectomy. The surgeons divide the thyrocervical trunk, from which of the following vessels does this structure most commonly originate?
Subclavian artery Common carotid artery Vertebral artery External carotid artery Internal carotid artery
The thyrocervical trunk is a branch of the subclavian artery. It arises from the first part between the subclavian artery and the inner border of scalenus anterior. It branches off the subclavian distal to the vertebral artery.
What is the first branch of the axillary artery?
Subscapular artery Lateral thoracic artery Thoraco acromial artery Superior thoracic artery Anterior circumflex humeral artery
The superior thoracic artery is the first branch of the axillary artery arises from the first part
Two branches arise from the second part, thoraco acromial and lateral thoracic
Three branches from the third part, subscapular artery, anterior and posterior circumflex humeral arteries
The following structures are closely related to the brachiocephalic artery except:
Trachea posteriorly Right brachiocephalic vein Inferior thyroid vein Right recurrent laryngeal nerve None of the above
There is no brachiocephalic artery on the left, however the left brachiocephalic vein lies anteriorly to the roots of all the 3 great arteries (including the brachiocephalic artery). The right recurrent laryngeal nerve has no relation to the brachiocephalic artery.
Which of the following structures separates the ulnar artery from the median nerve?
Brachioradialis Pronator teres Tendon of biceps brachii Flexor carpi ulnaris Brachialis
It lies deep to pronator teres and this separates it from the median nerve.
Which muscle is supplied by the superficial peroneal nerve?
Peroneus tertius Sartorius Adductor magnus Peroneus brevis Gracilis
Superficial peroneal nerve Supplies
Lateral compartment of leg: peroneus longus, peroneus brevis (action: eversion and plantar flexion)
A 32 year old motorcyclist is involved in a road traffic accident. His humerus is fractured and severely displaced. At the time of surgical repair the surgeon notes that the radial nerve has been injured. Which of the following muscles is least likely to be affected by an injury at this site?
Extensor carpi radialis brevis Brachioradialis Abductor pollicis longus Extensor pollicis brevis None of the above
None of the above
The radial nerve supplies the extensor muscles, abductor pollicis longus and extensor pollicis brevis (the latter two being innervated by the posterior interosseous branch of the radial nerve).
A man develops an infection in his external ear. The infection is extremely painful. Which of the following nerves conveys sensation from this region?
Occipital branch of the trigeminal nerve Vestibulocochlear nerve Facial nerve Auriculotemporal nerve Maxillary branch of the trigeminal nerve
The auriculotemporal nerve, which is derived from the mandibular branch of the trigeminal nerve supplies this area
Which muscle is responsible for causing flexion of the interphalangeal joint of the thumb?
Flexor pollicis longus Flexor pollicis brevis Flexor digitorum superficialis Flexor digitorum profundus Adductor pollicis
Flexor and extensor longus insert on the distal phalanx moving both the MCP and IP joints.
Which of the following structures separates the posterior cruciate ligament from the popliteal artery?
Oblique popliteal ligament Transverse ligament Popliteus tendon Biceps femoris Semitendinosus
The posterior cruciate ligament is separated from the popliteal vessels at its origin by the oblique popliteal ligament. The transverse ligament is located anteriorly.
