EMRCS ANATOMY 6 Flashcards
Which of the following types of epithelium lines the lumenal surface of the normal oesophagus?
Non keratinised stratified squamous epithelium Ciliated columnar epithelium Keratinised stratified squamous epithelium Non ciliated columnar epithelium None of the above
Non keratinised stratified squamous epithelium
The oesphagus is lined by non keratinised stratified squamous epithelium. Changes to glandular type epithelium occur as part of metaplastic processes in reflux.
Which of the following structures is not directly related to the right adrenal gland?
Diaphragm posteriorly Kidney inferiorly Right renal vein Inferior vena cava Hepato-renal pouch
Right renal vein
The right renal vein is very short and lies more inferiorly.
Which of the following aortic branches leaves the aorta approximately 1cm below the coeliac axis?
Renal artery Inferior mesenteric artery Superior mesenteric artery Lumbar artery Gonadal artery
Superior mesenteric artery
The SMA leaves the aorta approximately 1cm below the coeliac axis. This is usually a level of L1. It is crossed anteriorly by the splenic vein and the body of the pancreas. It runs downwards and forwards anterior to the uncinate process.
Through which of the structures listed below does the axillary nerve pass?
Quadrangular space Triangular space Subclavicular space Sub pectoral space Intercostal space
Quadrangular space
Axillary nerve passes through the quadrangular space
With respect to the basilic vein, which statement is false?
Its deep anatomical location makes it unsuitable for use as an arteriovenous access site in fistula surgery It originates from the dorsal venous network on the hand It travels up the medial aspect of the forearm Halfway between the shoulder and the elbow it lies deep to muscle It is joined by the brachial vein to form the axillary vein
Its deep anatomical location makes it unsuitable for use as an arteriovenous access site in fistula surgery
It is used in arteriovenous fistula surgery during a procedure known as a basilic vein transposition.
Mobilisation of the left lobe of the liver will facilitate surgical access to which of the following?
Abdominal oesophagus Duodenum Right colic flexure Right kidney Pylorus of stomach
Abdominal oesophagus
The fundus of the stomach is a posterior relation. The pylorus lies more inferolaterally. During a total gastrectomy division of the ligaments holding the left lobe of the liver will facilitate access to the proximal stomach and abdominal oesophagus. This manoeuvre is seldom beneficial during a distal gastrectomy.
The following statements relating to the ankle joint are true except?
Three groups of ligaments provide mechanical stability The sural nerve lies medial to the Achilles tendon at its point of insertion Eversion of the foot occurs at the sub talar joint The flexor hallucis longus tendon is the most posterior structure at the medial malleolus The saphenous nerve crosses the ankle joint.
The sural nerve lies medial to the Achilles tendon at its point of insertion
The sural nerve lies behind the distal fibula. Inversion and eversion are sub talar movements. The structures passing behind the medial malleolus from anterior to posterior include: tibialis posterior, flexor digitorum longus, posterior tibia vein, posterior tibial artery, nerve, flexor hallucis longus.
The oesophagus is constricted at the following levels apart from:
Cricoid cartilage Arch of the aorta Lower oesophageal sphincter Left main stem bronchus Diaphragmatic hiatus
Lower oesophageal sphincter
The oesophagus is not constricted at the level of the lower oesophageal sphincter.
A 19 year old man is playing rugby when he suddenly notices a severe pain at the posterolateral aspect of his right thigh. Which of the following muscle groups is most likely to have been injured?
Semimembranosus Semitendinosus Long head of biceps femoris Gastrocnemius Soleus
Long head of biceps femoris
The biceps femoris is the laterally located hamstring muscle. The semitendinosus and semimembranosus are located medially. Rupture of gastrocnemius and soleus may occur but is less common.
Which of the following is a branch of the third part of the axillary artery?
Superior thoracic Lateral thoracic Dorsal scapular Thoracoacromial Posterior circumflex humeral
Posterior circumflex humeral
The other branches include:
Subscapular
Anterior circumflex humeral
The dorsal scapular artery arises from the third part of the subclavian artery in most cases
Which of the following structures separates the intervertebral disks from the spinal cord?
Anterior longitudinal ligament Posterior longitudinal ligament Supraspinous ligament Interspinous ligament Ligamentum flavum
Posterior longitudinal ligament
The posterior longitudinal ligament overlies the posterior aspect of the vertebral bodies. It also overlies the posterior aspect of the intervertebral disks
At what level does the aorta bifurcate into the left and right common iliac arteries?
L1 L2 L3 L4 L5
L4
The aorta typically bifurcates at L4.
A 23 year old man is due to undergo a mitral valve repair for mitral regurgitation. Which of the following is a feature of the mitral valve?
Its closure is marked by the first heart sound It has two anterior cusps The chordae tendinae attach to the anterior cusps only The chordae tendinae anchor the valve directly to the wall of the left ventricle It is best auscultated in the left third interspace
Its closure is marked by the first heart sound
The mitral valve is best auscultated over the cardiac apex, where its closure marks the first heart sound. It has only two cusps. These are attached to chordae tendinae which themselves are linked to the wall of the ventricle by the papillary muscles.
A 23 year old lady with sialolithiasis of the submandibular gland is undergoing excision of the gland. Which of the following nerves is at risk as the duct is mobilised?
Lingual nerve Buccal nerve Facial nerve Glossopharyngeal Vagus
Lingual nerve
The lingual nerve wraps around Whartons duct. The lingual nerve provides sensory supply to the anterior 2/3 of the tongue
Which of the following is true in connection with the phrenic nerves?
They both lie anterior to the hilum of the lungs They are derived from spinal roots C 2,3,4 They pierce the diaphragm at the level of T7 They consist of motor fibres only None of the above
They both lie anterior to the hilum of the lungs
They both lie anterior to the hilum of the lung. The phrenic nerves have both motor and sensory functions. For this reason sub diaphragmatic pathology may cause referred pain to the shoulder.
A 32 year old man presents with an inguinal hernia and undergoes an open surgical repair. The surgeons decide to place a mesh on the posterior wall of the inguinal canal to complete the repair, which of the following structures will lie posterior to the mesh?
Transversalis fascia External oblique Rectus abdominis Obturator nerve None of the above
Transversalis fascia
This is actually quite a straightforward question. It is simply asking for the structure that forms the posterior wall of the inguinal canal. This is composed of the transversalis fascia, the conjoint tendon and more laterally the deep inguinal ring.
A 22 year old man is involved in a fight and is stabbed in the posterior aspect of his right leg. The knife passes into the popliteal fossa. He sustains an injury to his tibial nerve. Which muscle is least likely to be compromised as a result?
Tibialis posterior Flexor hallucis longus Flexor digitorum brevis Soleus Peroneus tertius
Peroneus tertius
Peroneus tertius is innervated by the deep peroneal nerve.
Which of the following overlies the outer muscular layer of the intrathoracic oesophagus?
Serosa Meissners plexus Auerbach's plexus Loose connective tissue None of the above
Loose connective tissue
The oesophagus has no serosal covering and hence holds sutures poorly. The Auerbach’s and Meissner’s nerve plexuses lie in between the longitudinal and circular muscle layers and submucosally. The sub mucosal location of the Meissner’s nerve plexus facilitates its sensory role.
Which nerve lies medially on the thyroid gland, in the groove between the oesophagus and trachea?
Vagus nerve External laryngeal nerve Recurrent laryngeal nerve Ansa cervicalis Phrenic nerve
Recurrent laryngeal nerve
The recurrent laryngeal nerve may be injured at this site during ligation of the inferior thyroid artery.
At which of the following spinal levels does the oesophagus pass through the diaphragm into the abdominal cavity?
L2 L1 T10 T5 T12
T10
The oesophagus passes into the abdomen at T10.
Which of the following nerve roots contribute nerve fibres to the ansa cervicalis?
C1 only C1, C2 and C3 C2, C3 and C6 C2, C4 and C5 C4, C5 and C6
C1, C2 and C3
The ansa cervicalis is composed of a superior and inferior root, derived from C1, C2 and C3
The anterior interosseous nerve is a branch of which of the following?
Ulnar nerve Superficial branch of the radial nerve Axillary nerve Deep branch of the radial nerve Median nerve
Median nerve
The anterior interosseous nerve (volar interosseous nerve) is a branch of the median nerve that supplies the deep muscles on the front of the forearm, except the ulnar half of the flexor digitorum profundus.
At which of the following anatomical locations does the common peroneal nerve bifurcate into the superficial and deep peroneal nerves?
Immediately anterior to the linea aspera At the lateral aspect of the neck of the fibula Within the substance of tibialis anterior muscle At the inferomedial aspect of the popliteal fossa Under the medial head of gastrocnemius
At the lateral aspect of the neck of the fibula
The common peroneal nerve bifurcates at the neck of the fibula (where it is most likely to be injured).
A 48 year old motor cyclist sustains a complex lower limb fracture in a motor accident. For a time the popliteal artery is occluded and eventually repaired. Subsequently he develops a compartment syndrome and the anterior and superficial posterior compartments of the lower leg are decompressed. Unfortunately, the operating surgeon neglects to decompress the deep posterior compartment. Which of the following muscles is least likely to be affected as a result?
Flexor digitorum longus Plantaris Tibialis posterior Flexor hallucis longus None of the above
Plantaris
The plantaris muscle lies within the superficial posterior compartment of the lower leg.
A 23 year old lady is undergoing a trendelenberg procedure for varicose veins. During the dissection of the saphenofemoral junction, which of the structures listed below is most liable to injury?
Superficial circumflex iliac artery Superficial circumflex iliac vein Femoral artery Femoral nerve Deep external pudendal artery
Deep external pudendal artery
The deep external pudendal artery runs under the long saphenous vein close to its origin and may be injured. It is at greatest risk of injury during the flush ligation of the saphenofemoral junction. Provided an injury is identified and vessel ligated, injury is seldom associated with any serious adverse sequelae.
Considering the pituitary gland, which of the following is false?
The anterior pituitary secretes thyroid stimulating hormone The anterior pituitary develops from Rathkes pouch Patients with craniopharyngioma may develop bi temporal hemianopia The pituitary is in direct contact with the optic chiasm The posterior pituitary secretes oxytocin via a positive feedback loop
The pituitary is in direct contact with the optic chiasm
Although the optic chiasm is closely related to the pituitary, and craniopharyngiomas may compress this structure leading to bitemporal hemianopia, it is separated from the chiasm itself by a dural fold.
A 24 year old man is involved in a fight and his face is cut with a knife. The wound lies immediately anterior to the tragus of the ear and extends anteriorly. The wound is surgically explored and the laceration is found to be mainly superficial. It extends slightly more deeply immediately inferior to the main trunk of the facial nerve. Bleeding is observed, from which of the following is it most likely to originate?
External carotid artery Retromandibular vein Occipital artery Maxillary artery Ascending pharyngeal artery
Retromandibular vein
The retromandibular vein lies slightly more deeply than the facial nerve in the parotid gland. It is formed from the maxillary and superficial temporal vein.
A 52 year female post hysterectomy attends clinic. She reports pain and reduced sensation over the medial aspect of her thigh. Clinically thigh adduction is weak. What is the most likely nerve injury?
Obturator nerve Sciatic nerve Femoral nerve L3 cord compression Deep peroneal nerve
Obturator nerve
The obturator nerve supplies sensation to the medial aspect of the thigh and causes adduction and internal rotation of the thigh.
Injury occurs during pelvic or abdominal surgery.
L3 cord compression is unlikely.
An ENT surgeon is performing a radical neck dissection. She wishes to fully expose the external carotid artery. To do so she inserts a self retaining retractor close to its origin. Which of the following structures lies posterolaterally to the external carotid at this point?
Superior thyroid artery Internal carotid artery Lingual artery Facial artery None of the above
Internal carotid artery
The internal carotid artery lies posterolaterally to the external carotid artery at it’s origin from the common carotid. The superior thyroid, lingual and facial arteries all arise from its anterior surface.
In Froment’s test which muscle function is tested?
Flexor pollicis longus Abductor pollicis longus Abductor pollicis brevis Adductor pollicis Opponens pollicis
Adductor pollicis
Froment’s sign
Assess for ulnar nerve palsy
Adductor pollicis muscle function tested
A 22 year old man is involved in a fight outside a nightclub. He is stabbed in the back, on the left side, approximately 3cm below the 12th rib in the mid scapular line. The structure most likely to be injured first as a result is the:
Spleen Left kidney Left adrenal gland Left ureter None of the above
Left kidney
The left kidney lies in this location and is the most likely structure to be injured. The Spleen lies more superiorly, and the left adrenal and ureter are unlikely to be injured in isolation.
A 28 year old man has a pleomorphic adenoma and the decision is made to resect this surgically. Which of the following structures is least likely to be encountered during surgical resection of the parotid gland?
External carotid artery Retromandibular vein Auriculotemporal nerve Mandibular nerve Zygomatic branch of the facial nerve
Mandibular nerve
The mandibular nerve is well separated from the parotid gland
A 23 year old man is undergoing a hernia repair and the mesh is to be sutured to the inguinal ligament. From which of the following does the inguinal ligament arise?
Transversus abdominis fascia Internal oblique Rectus sheath Rectus abdominis muscle External oblique aponeurosis
External oblique aponeurosis
The inguinal ligament is formed by the external oblique aponeurosis. It runs from the pubic tubercle to the anterior superior iliac spine.
A 56 year old man is undergoing a carotid endarterectomy. The internal carotid artery is mobilised. How many branches does this vessel give off in the neck?
0 1 2 3 6
0
The internal carotid does not have any branches in the neck.
Which of the following is a content of the adductor canal?
Saphenous nerve Sural nerve Femoral nerve Profunda branch of the femoral artery Saphenous vein
Saphenous nerve
It contains the saphenous nerve and the superficial branch of the femoral artery.
A 56 year old man is undergoing a high anterior resection. Which of the following structures is at greatest risk of injury in this procedure?
Superior mesenteric artery Left ureter External iliac vein External iliac artery Inferior vena cava
Left ureter
the structure at greatest risk and most frequently encountered is the left ureter.
From which of these foraminae does the opthalmic branch of the trigeminal nerve exit the skull?
Foramen ovale Foramen rotundum Foramen spinosum Superior orbital fissure Foramen magnum
Superior orbital fissure
The opthalmic branch of the trigeminal nerve exits the skull through the superior orbital fissure.
A 56 year old lady with metastatic breast cancer develops an oestolytic deposit in the proximal femur. One morning whilst getting out of bed she notices severe groin pain. X-rays show that the lesser trochanter has been avulsed. Which muscle is the most likely culprit?
Vastus lateralis Psoas major Piriformis Gluteus maximus Gluteus medius
Psoas major
The psoas major inserts into the lesser trochanter and contracts when raising the trunk from the supine position. When oestolytic lesions are present in the femur the lesser trochanter may be avulsed.
Which of the following nerves is responsible for the motor innervation of the sternocleidomastoid muscle?
Ansa cervicalis Accessory nerve Hypoglossal nerve Facial nerve Vagus nerve
Accessory nerve
The motor supply to the sternocleidomastoid is from the accessory nerve. The ansa cervicalis supplies sensory information from the muscle.
A 42 year old lady undergoes a difficult cholecystectomy and significant bleeding is occurring. The surgeons place a vascular clamp transversely across the anterior border of the epiploic foramen. Which of the following structures will be occluded in this manoeuvre?
Cystic artery Cystic duct Left gastric artery Portal vein None of the above
Portal vein
The portal vein, hepatic artery and common bile duct are occluded.
A 56 year old lady undergoes a Hartmann’s style resection of the sigmoid colon, with ligation of the vessels close to the colon. Which of the following vessels will be responsible to supplying the rectal stump directly?
Superior mesenteric artery Middle colic artery Superior rectal artery Inferior mesenteric artery External iliac artery
Superior rectal artery
This question is addressing the blood supply to the rectum. Which is supplied by the superior rectal artery. High ligation of the IMA may compromise this structure. However, the question states that during the Hartmans procedure the vessels were ligated close to the bowel. Implying that the superior rectal was preserved.
Which of the nerves listed below is at greatest risk of injury with a laceration to the upper lateral margin of the popliteal fossa?
Common peroneal nerve Sural nerve Sciatic nerve Saphenous nerve Tibial nerve
Common peroneal nerve
The sural nerve exits at the lower infero-lateral aspect of the fossa and is more at risk in short saphenous vein surgery. The tibial nerve lies more medially and is even less likely to be injured in this location.
Which option is false in relation to the trigeminal nerve?
The nerve originates at the pons The posterior scalp is supplied by the trigeminal nerve The maxillary nerve exits via the foramen rotundum The maxillary nerve is purely sensory The motor root is not in the trigeminal ganglion
The posterior scalp is supplied by the trigeminal nerve
The posterior scalp is supplied by C2-C3.
A 45 year old man is undergoing a lymph node biopsy from the posterior triangle of his neck. Which structure forms the posterior border of this region?
Trapezius muscle Diagastric muscle External jugular vein Omohyoid muscle Sternocleidomastoid muscle
Trapezius muscle
Boundaries
Apex Sternocleidomastoid and the Trapezius muscles at the Occipital bone
Anterior Posterior border of the Sternocleidomastoid
Posterior Anterior border of the Trapezius
Base Middle third of the clavicle
On inspecting the caecum, which of the following structures is most likely to be identified at the point at which all the tenia coli converge?
Gonadal vessels Appendix base Appendix tip Ileocaecal valve Ileocolic artery
Appendix base
The tenia coli converge at the base of the appendix.
A 42 year old lady has had an axillary node clearance for breast malignancy. Post operatively she reports weakness of the shoulder. She is unable to push herself forwards from a wall with the right arm and the scapula is pushed out medially from the chest wall. What is the most likely nerve injury?
C5, C6 C8, T1 Axillary nerve Long thoracic nerve Spinal accessory nerve
Long thoracic nerve
The patient has a winged scapula caused by damage to the long thoracic nerve (C5,6,7) during surgery. The long thoracic nerve innervates serratus anterior. Serratus anterior causes pushing out of the scapula during a punch.
A 36 year old male is admitted for elective surgery for a lymph node biopsy in the supraclavicular region. Post operatively the patient has difficulty shrugging his left shoulder. What is the most likely reason?
Phrenic nerve lesion Axillary nerve lesion C5, C6 root lesion C8, T1 root lesion Accessory nerve lesion
Accessory nerve lesion
The accessory nerve lies in the posterior triangle and may be injured in this region. Apart from problems with shrugging the shoulder, he may also have difficulty lifting his arm above his head.
How many fissures are present within the right lung?
One Three Two Four Five
Two
The right lung has an oblique and horizontal fissure. The upper oblique fissure separates the inferior from the middle and upper lobes. The short horizontal fissure separates the superior and middle lobes.
A 20 year old man presents to the Emergency Department with a stab injury to the thenar eminence. On examination, he is found to have a 2 cm long laceration with loss of sensation in the thumb and index finger and weakness: of the thenar muscles. Which of the following structures is most likely to have been injured?
Anterior interosseous nerve Recurrent branch of the median nerve Sensory and motor branches of the median nerve Sensory and motor branches of the radial nerve Sensory and motor branches of the ulnar nerve
Sensory and motor branches of the median nerve
The question describes both a motor and sensory deficit. This means that injury cannot be isolated to the recurrent branch of the median nerve in isolation as this only provides motor function. Sensation via the palmar cutaneous branches must also be compromised and it is for this reason the correct answer is injury to motor and sensory branches of the median nerve.
Which of the following muscles is supplied by the musculocutaneous nerve?
Brachialis Latissimus dorsi Flexor carpi ulnaris Teres minor Triceps
Brachialis
Muscles innervated by the musculocutaneous nerve BBC:
Biceps brachii
Brachialis
Coracobrachialis
