EMRCS ANATOMY 5 Flashcards
How many compartments are there in the lower leg?
2 1 3 5 4
4
The posterior compartment of the lower leg has both superficial and deep posterior layers, together with the anterior and lateral compartments this allows for four compartments. Decompression of the deep posterior compartment during fasciotomy may be overlooked with significant sequelae.
Which structure is least likely to be found at the level of the sternal angle?
Left brachiocephalic vein Intervertebral discs T4-T5 Start of aortic arch 2nd pair of costal cartilages Bifurcation of the trachea into left and right bronchi
Left brachiocephalic vein
The left brachiocephalic vein lies posterior to the manubrium, at the level of its upper border. The sternal angle refers to the transition between manubrium and sternum and therefore will not include the left brachiocephalic vein.
A 53 year old man is undergoing a left hemicolectomy for carcinoma of the descending colon. From which embryological structure is this region of the gastrointestinal tract derived?
Vitellino-intestinal duct Hind gut Mid gut Fore gut Woolffian duct
Hind gut
The left colon is embryologically part of the hind gut. Which accounts for its separate blood supply via the IMA
What is the most useful test to clinically distinguish between an upper and lower motor neurone lesion of the facial nerve?
Blow cheeks out Loss of chin reflex Close eye Raise eyebrow Open mouth against resistance
Raise eyebrow
Upper motor neurone lesions of the facial nerve- Paralysis of the lower half of face.
Lower motor neurone lesion- Paralysis of the entire ipsilateral face.
An 18 year old man is stabbed in the axilla during a fight. His axillary artery is lacerated and repaired. However, the surgeon neglects to repair an associated injury to the upper trunk of the brachial plexus. Which of the following muscles is least likely to demonstrate impaired function as a result?
Palmar interossei Infraspinatus Brachialis Supinator brevis None of the above
Palmar interossei
The palmar interossei are supplied by the ulnar nerve. Which lies inferiorly and is therefore less likely to be injured.
A 23 year old man is involved in a fight, during the dispute he sustains a laceration to the posterior aspect of his right arm, approximately 2cm proximal to the olecranon process. On assessment in the emergency department he is unable to extend his elbow joint. Which of the following tendons is most likely to have been cut?
Triceps Pronator teres Brachioradialis Brachialis Biceps
Triceps
The triceps muscle extends the elbow joint. The other muscles listed all produce flexion of the elbow joint.
You excitedly embark on your first laparoscopic cholecystectomy and during the operation the anatomy of Calots triangle is more hostile than anticipated. Whilst trying to apply a haemostatic clip you avulse the cystic artery. This is followed by brisk haemorrhage. From which source is this most likely to originate ?
Right hepatic artery Portal vein Gastroduodenal artery Liver bed Common hepatic artery
Right hepatic artery
The cystic artery is a branch of the right hepatic artery. There are recognised variations in the anatomy of the blood supply to the gallbladder. However, the commonest situation is for the cystic artery to branch from the right hepatic artery
A 43 year old man suffers a pelvic fracture which is complicated by an injury to the junction of the membranous urethra to the bulbar urethra. In which of the following directions is the extravasated urine most likely to pass?
Posteriorly into extra peritoneal tissues Laterally into the buttocks Into the abdomen Anteriorly into the connective tissues surrounding the scrotum None of the above
Anteriorly into the connective tissues surrounding the scrotum
When urethral rupture occurs as in this case the urine will tend to pass anteriorly because the fascial condensations will prevent lateral and posterior passage of the urine.
Which of the following does not pass through the superior orbital fissure?
Oculomotor nerve Abducens nerve Ophthalmic artery Ophthalmic division of the trigeminal nerve Ophthalmic veins
Ophthalmic artery
The ophthalmic artery, a branch of the internal carotid enters the orbit with the optic nerve in the canal.
Which nerve supplies the 1st web space of the foot?
Popliteal nerve Superficial peroneal nerve Deep peroneal nerve Tibial nerve Saphenous nerve
Deep peroneal nerve
The first web space is innervated by the deep peroneal nerve
During the course of a radical gastrectomy the surgeons detach the omentum and ligate the right gastro-epiploic artery. From which vessel does it originate?
Superior mesenteric artery Inferior mesenteric artery Coeliac axis Common hepatic artery Gastroduodenal artery
Gastroduodenal artery
The gastroduodenal artery arises at the superior part of the duodenum and descends behind it to terminate at its lower border. It terminates by dividing into the right gastro-epiploic artery and the superior pancreaticoduodenal artery. The right gastro-opiploic artery passes to the left and passes between the layers of the greater omentum to anastomose with the left gastro-epiploic artery.
Which of the following is not an intrinsic muscle of the hand?
Opponens pollicis Palmaris longus Flexor pollicis brevis Flexor digiti minimi brevis Opponens digiti minimi
Palmaris longus
Palmaris longus originates in the forearm.
A man with lung cancer and bone metastasis in the thoracic spinal vertebral bodies, sustains a pathological fracture at the level of T4. The fracture is unstable and the spinal cord is severely compressed at this level. Which of the findings below will not be present 6 weeks after injury?
Extensor plantar reflexes Spasticity of the lower limbs Diminished patellar tendon reflex Urinary incontinence Sensory ataxia
Diminished patellar tendon reflex
A thoracic cord lesion causes spastic paraperesis, hyperrflexia and extensor plantar responses (UMN lesion), incontinence, sensory loss below the lesion and ‘sensory’ ataxia.These features typically manifest several weeks later, once spinal shock (in which areflexia predominates) has resolved.
Through which of the following foramina does the genital branch of the genitofemoral nerve exit the abdominal cavity?
Superficial inguinal ring Sciatic notch Obturator foramen Femoral canal Deep inguinal ring
Deep inguinal ring
The genitofemoral nerve divides into two branches as it approaches the inguinal ligament. The genital branch passes anterior to the external iliac artery through the deep inguinal ring into the inguinal canal. It communicates with the ilioinguinal nerve in the inguinal canal (though this is seldom of clinical significance)
A 28 year old man lacerates the posterolateral aspect of his wrist with a knife in an attempted suicide. On arrival in the emergency department the wound is inspected and found to be located over the lateral aspect of the extensor retinaculum (which is intact). Which of the following structures is at greatest risk of injury?
Superficial branch of the radial nerve Radial artery Dorsal branch of the ulnar nerve Tendon of extensor carpi radialis brevis Tendon of extensor digiti minimi
Superficial branch of the radial nerve
The superficial branch of the radial nerve passes superior to the extensor retinaculum in the position of this laceration and is at greatest risk of injury. The dorsal branch of the ulnar nerve and artery also pass superior to the extensor retinaculum but are located medially.
A 43 year old man is reviewed in the clinic following a cardiac operation. A chest x-ray is performed and a circular radio-opaque structure is noted medial aspect of the 4th intercostal space on the left. Which of the following procedures is the patient most likely to have undergone?
Aortic valve replacement with metallic valve Tricuspid valve replacement with metallic valve Tricuspid valve replacement with porcine valve Pulmonary valve replacement with porcine valve Mitral valve replacement with metallic valve
Mitral valve replacement with metallic valve
A 63 year old lady is diagnosed as having an endometrial carcinoma arising from the uterine body. To which nodal region will the tumour initially metastasise?
Para aortic nodes Iliac lymph nodes Inguinal nodes Pre sacral nodes Mesorectal lymph nodes
Iliac lymph nodes
Tumours of the uterine body will tend to spread to the iliac nodes initially. Tumour expansion crossing different nodal margins this is of considerable clinical significance, if nodal clearance is performed during a Wertheims type hysterectomy.
Transection of the radial nerve at the level of the axilla will result in all of the following except:
Loss of elbow extension. Loss of extension of the interphalangeal joints. Loss of metacarpophalangeal extension. Loss of triceps reflex. Loss of sensation overlying the first dorsal interosseous.
Loss of sensation overlying the first dorsal interosseous.
These may still extend by virtue of retained lumbrical muscle function
Which of the following structures is not located in the superficial perineal space in females?
Posterior labial arteries Pudendal nerve Superficial transverse perineal muscle Greater vestibular glands None of the above
Pudendal nerve
The pudendal nerve is located in the deep perineal space and then branches to innervate more superficial structures.
Which of the following is not a branch of the hepatic artery?
Pancreatic artery Cystic artery Right gastric artery Right hepatic artery Gastroduodenal artery
Pancreatic artery
The pancreatic artery is a branch of the splenic artery.
Which of the following structures does not pass close to the piriformis muscle in the greater sciatic foramen?
Sciatic nerve Posterior cutaneous nerve of the thigh Inferior gluteal artery Obturator nerve None of the above
Obturator nerve
The obturator nerve does not pass through the greater sciatic foramen.
A 56 year old man is undergoing a right nephrectomy. The surgeons divide the renal artery. At what level does this usually branch off the abdominal aorta?
T9 L2 L3 T10 L4
L2
The renal arteries usually branch off the aorta on a level with L2.
A 23 year old man is shot in the chest during a robbery. The left lung is lacerated and is bleeding. An emergency thoracotomy is performed. The surgeons place a clamp over the hilum of the left lung. Which of the following structures lies most anteriorly at this level?
Vagus nerve Oesophagus Descending aorta Phrenic nerve Azygos vein
Phrenic nerve
The phrenic nerve lies anteriorly at this point. The vagus passes anteriorly and then arches backwards immediately superior to the root of the left bronchus, giving off the recurrent laryngeal nerve as it does so.
A 22 year old man presents with appendicitis. At operation the appendix is retrocaecal and difficult to access. Division of which of the following anatomical structures should be undertaken?
Ileocolic artery Mesentery of the caecum Gonadal vessels Lateral peritoneal attachments of the caecum Right colic artery
Lateral peritoneal attachments of the caecum
The commonest appendiceal location is retrocaecal. Those struggling to find it at operation should trace the tenia to the caecal pole where the appendix is located. If it cannot be mobilised easily then division of the lateral caecal peritoneal attachments (as for a right hemicolectomy) will allow caecal mobilisation and facilitate the procedure
Which of the following muscles does not adduct the shoulder?
Teres major Pectoralis major Coracobrachialis Supraspinatus Latissimus dorsi
Supraspinatus
Supraspinatus is an abductor of the shoulder.
Which of these muscles is innervated by the cervical branch of the facial nerve?
Masseter Sternocleidomastoid Platysma Geniohyoid Sternothyroid
Platysma
The cervical branch of the facial nerve innervates platysma.
During a thyroidectomy the surgeons ligate the inferior thyroid artery. From which vessel does this structure usually originate?
External carotid artery Thyrocervical trunk Internal carotid artery Subclavian artery Vertebral artery
Thyrocervical trunk
The inferior thyroid artery originates from the thyrocervical trunk. This is a branch of the subclavian artery.
A 56 year old man is left impotent following an abdomino-perineal excision of the colon and rectum. What is the most likely explanation?
Psychosexual issues related to an end colostomy Damage to the sacral venous plexus during total mesorectal excision Damage to the left ureter during sigmoid mobilisation Damage to the hypogastric plexus during mobilisation of the inferior mesenteric artery Damage to the internal iliac artery during total mesorectal excision
Damage to the hypogastric plexus during mobilisation of the inferior mesenteric artery
Autonomic nerve injury is the most common cause.
A 73 year old man is due to undergo a radical prostatectomy for carcinoma of the prostate gland. To which of the following lymph nodes will the tumour drain primarily?
Para aortic Internal iliac Superficial inguinal Meso rectal None of the above
Internal iliac
The prostate lymphatic drainage is primarily to the internal iliac nodes and also the sacral nodes. Although internal iliac is the first site.
Which of the following statements relating to the vertebral column is false?
There are 7 cervical vertebrae The cervical and lumbar lordosis are secondary curves developing after birth due to change in shape of the intervertebral discs The lumbar vertebrae do not have a transverse process foramina The lumbar vertebrae receive blood directly from the aorta The spinous process is formed by the junction of the pedicles posteriorly
The spinous process is formed by the junction of the pedicles posteriorly
The spinous process is formed by 2 laminae posteriorly.
A 78 year old lady falls over in her nursing home and sustains a displaced intracapsular fracture of the femoral neck. A decision is made to perform a hemi arthroplasty through a lateral approach. Which of these vessels will be divided to facilitate access?
Saphenous vein Superior gluteal artery Superficial circumflex iliac artery Profunda femoris artery Transverse branch of the lateral circumflex artery
Transverse branch of the lateral circumflex artery
During the Hardinge style lateral approach the transverse branch of the lateral circumflex artery is divided to gain access
A 73 year old man undergoes a sub total oesophagectomy with anastomosis of the stomach to the cervical oesophagus. Which vessel will be primarily responsible for the arterial supply to the oesophageal portion of the anastomosis?
Superior thyroid artery Internal carotid artery Direct branches from the thoracic aorta Inferior thyroid artery Subclavian artery
Inferior thyroid artery
The cervical oesophagus is supplied by the inferior thyroid artery. The thoracic oesophagus (removed in this case) is supplied by direct branches from the thoracic aorta.
Which of the following structures is not closely related to the brachial artery?
Ulnar nerve Median nerve Cephalic vein Long head of triceps Median cubital vein
Cephalic vein
The cephalic vein lies superficially and on the contralateral side of the arm to the brachial artery
Which ligament keeps the head of the radius connected to the radial notch of the ulna?
Annular (orbicular) ligament Quadrate ligament Radial collateral ligament of the elbow Ulnar collateral ligament Radial collateral ligament
Annular (orbicular) ligament
The annular ligament connects the radial head to the radial notch of the ulna
A 38 year old man presents to the clinic with shoulder weakness. On examination he has an inability to initiate shoulder abduction. Which of the nerves listed below is least likely to be functioning normally?
Suprascapular nerve Medial pectoral nerve Axillary nerve Median nerve Radial nerve
Suprascapular nerve
It innervates both supraspinatus and infraspinatus
Which of the following statements relating to the Cavernous Sinus is false?
The pituitary gland lies medially The internal carotid artery passes through it The temporal lobe of the brain is a lateral relation The mandibular branch of the trigeminal and optic nerve lie on the lateral wall The ophthalmic veins drain into the anterior aspect of the sinus
The mandibular branch of the trigeminal and optic nerve lie on the lateral wall
The veins that drain into the sinus are important as sepsis can cause cavernous sinus thrombosis. The maxillary branch of the trigeminal and not the mandibular branches pass through the sinus
Which of the following is not a branch of the subclavian artery?
Superior thyroid artery Vertebral artery Thyrocervical trunk Internal thoracic artery Dorsal scapular artery
Superior thyroid artery
Superior thyroid artery is a branch of the external carotid artery.
During the repair of an atrial septal defect the surgeons note that blood starts to leak from the coronary sinus. Which structure forms the largest tributary of the coronary sinus?
Thebesian veins Great cardiac vein Oblique vein Small cardiac veins None of the above
Great cardiac vein
The great cardiac vein runs in the anterior interventricular groove, and is the largest tributary of the coronary sinus. The thebesian veins drain into the heart directly.
Which of the following vessels provides the greatest contribution to the arterial supply of the breast?
External mammary artery Thoracoacromial artery Internal mammary artery Lateral thoracic artery Subclavian artery
Internal mammary artery
60% of the arterial supply to the breast is derived from the internal mammary artery. The external mammary and lateral thoracic arteries also make a significant (but lesser) contribution. This is of importance clinically in performing reduction mammoplasty procedures.
Which of the following muscles is supplied by the external laryngeal nerve?
Transverse arytenoid Cricothyroid Thyro-arytenoid Posterior crico-arytenoid Oblique arytenoid
Cricothyroid
The others are all supplied by the recurrent laryngeal nerve.
A 28 year old man has sustained a non salvageable testicular injury to his left testicle. The surgeon decides to perform an orchidectomy and divides the left testicular artery. From which of the following does this vessel originate?
Abdominal aorta Internal iliac artery Inferior epigastric artery Inferior vesical artery External iliac artery
Abdominal aorta
The testicular artery is a branch of the abdominal aorta.
During a carotid endarterectomy the internal carotid artery is cross clamped. Assuming that no shunt is inserted, which of the following vessels will not have diminished or absent flow as a result?
Anterior cerebral artery Ophthalmic artery Middle cerebral artery Maxillary artery None of the above
Maxillary artery
The maxillary artery is a branch of the external carotid artery.
A 72 year old lady with osteoporosis falls and sustains an intracapsular femoral neck fracture. The fracture is completely displaced. Which of the following vessels is the main contributor to the arterial supply of the femoral head?
Deep external pudendal artery Superficial femoral artery External iliac artery Circumflex femoral arteries Superficial external pudendal artery
Circumflex femoral arteries
The vessels which form the anastomoses around the femoral head are derived from the medial and lateral circumflex femoral arteries. These are usually derived from the profunda femoris artery.
A 21 year old man is hit with a hammer and sustains a depressed skull fracture at the vertex. Which of the following sinuses is at risk in this injury?
Superior sagittal sinus Inferior petrosal sinus Transverse sinus Inferior sagittal sinus Straight sinus
Superior sagittal sinus
The superior sagittal sinus is at greatest risk in this pattern of injury. This sinus begins at the front of the crista galli and courses backwards along the falx cerebri. It becomes continuous with the right transverse sinus near the internal occipital protuberance.
A 44 year old man is stabbed in the back and the left kidney is injured. A haematoma forms, which of the following fascial structures will contain the haematoma?
Waldeyers fascia Sibsons fascia Bucks fascia Gerotas fascia Denonvilliers fascia
Gerotas fascia
Waldeyers fascia- Posterior ano-rectum Sibsons fascia- Lung apex Bucks fascia- Base of penis Gerotas fascia- Surrounding kidney Denonvilliers fascia- Between rectum and prostate
A baby is found to have a Klumpke’s palsy post delivery. Which of the following is most likely to be present?
Loss of flexors of the wrist Weak elbow flexion Pronation of the forearm Adducted shoulder Shoulder medially rotated
Loss of flexors of the wrist
Features of Klumpkes Paralysis
Claw hand (MCP joints extended and IP joints flexed)
Loss of sensation over medial aspect of forearm and hand
Horner’s syndrome
Loss of flexors of the wrist
A 22 year old man undergoes a superficial parotidectomy for a pleomorphic adenoma. The operation does not proceed well and a diathermy malfunction results in division of the buccal branch of the facial nerve. Which of the following muscles will not demonstrate impaired function as a result?
Zygomaticus minor Mentalis Buccinator Levator anguli oris Risorius
Mentalis
At which of the following vertebral body levels does the common carotid artery typically bifurcate into the external and internal carotid arteries?
C4 C2 C1 C6 C7
C4
It terminates at the upper border of the thyroid cartilage, Which is usually located at C4.
A man is stabbed in the chest to the right of the manubriosternal angle. Which structure is least likely to be injured in this case?
Right pleura The trachea Right phrenic nerve Right recurrent laryngeal nerve Brachiocephalic vein
Right recurrent laryngeal nerve
The right recurrent laryngeal nerve branches off the right vagus more proximally and arches posteriorly round the subclavian artery. So of the structures given it is the least likely to be injured.
An 18 year old man is stabbed in the neck and has to undergo repair of a laceration to the internal carotid artery. Post operatively he is noted to have a Horners syndrome. Which of the following will not be present?
Apparent enopthalmos Loss of sweating on the entire ipsilateral side of the face Constricted pupil Mild ptosis Normal sympathetic activity in the torso
Loss of sweating on the entire ipsilateral side of the face
The anhidrosis will be mild as this is a distal lesion and at worst only a very limited area of the ipsilateral face will be anhidrotic.
