EMRCS ANATOMY 7 Flashcards by yamin bocha

Which cranial nerve supplies the motor fibres of styloglossus?

	Facial
	Trigeminal
	Vagus
	Hypoglossal
	Glossopharyngeal

Hypoglossal

The hypoglossal nerve supplies motor innervation to all extrinsic and intrinsic muscles of the tongue. The only possible exception to this is palatoglossus, which is jointly innervated by the vagus and accessory nerves.

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What is the most inferior anterior aortic branch?

	Median sacral artery
	Inferior mesenteric artery
	Lumbar artery
	Superior mesenteric artery
	Gonadal artery

Inferior mesenteric artery

The IMA leaves the front of the aorta usually about 3 to 4cm superior to its bifurcation. The median sacral is not an anterior branch.

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Which of the following statements relating to the posterior cerebral artery is false?

It supplies the visual cortex
It is closely related to the 3rd cranial nerve
It is a branch of the basilar artery
It is connected to the circle of Willis via the superior cerebellar artery
When occluded may result in contralateral loss of field of vision

It is connected to the circle of Willis via the superior cerebellar artery

The posterior cerebral arteries are formed by the bifurcation of the basilar artery and is connected to the circle of Willis via the posterior communicating artery

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An elderly man falls and lands on his hip. On examination, his hip is tender to palpation and x-rays are taken. There are concerns that he may have an intertrochanteric fracture. What is the normal angle between the femoral neck and the femoral shaft?

130o

The normal angle in males between the femoral head and shaft is 130o. Changes to this angle may occur as a result of disease or pathology and should be investigated.
Females have an angle that is around 110-120o

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A 22 year old man suffers a compound fracture of the tibia. During attempted surgical repair the deep peroneal nerve is divided. Which of the following muscles will not be affected as a result?

	Tibialis anterior
	Peroneus longus
	Extensor hallucis longus
	Extensor digitorum longus
	Peroneus tertius

Peroneus longus

Peroneus longus is innervated by the superficial peroneal nerve (L4, L5, S1).

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A 17 year old male presents to the clinic. He complains of difficulty using his left hand. It has been a persistent problem since he sustained a distal humerus fracture as a child. On examination, there is diminished sensation overlying the hypothenar eminence and medial one and half fingers. What is the most likely nerve lesion?

	Anterior interosseous nerve
	Posterior interosseous nerve
	Ulnar nerve
	Median nerve
	Radial nerve

Ulnar nerve

This sensory deficit pattern is most consistent with ulnar nerve injury.

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An 18 year old athlete attends orthopaedic clinic reporting pain and swelling over the medial aspect of the knee joint. The pain occurs when climbing the stairs, but is not present when walking on flat ground. Clinically there is pain over the medial, proximal tibia and the McMurray test is negative. What is the most likely cause of this patient’s symptoms?

	Anterior cruciate ligament tear
	Prepatellar bursitis
	Medial meniscus injury
	Pes Anserinus Bursitis
	Fracture of tibia

Pes Anserinus Bursitis

Pes Anserinus Bursitis is common in sportsmen due to overuse injuries. The main sign is of pain in the medial proximal tibia. As the McMurray test is negative, medial meniscal injury is excluded.

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Which of the following structures lies most posteriorly at the porta hepatis?

	Cystic artery
	Common hepatic artery
	Left hepatic artery
	Portal vein
	Common bile duct

Portal vein

The portal vein is the most posterior structure at the porta hepatis.The common bile duct is a continuation of the common hepatic duct and is formed by the union of the common hepatic duct and the cystic duct.

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A 76 year old man is undergoing an abdominal aortic aneurysm repair. The surgeons occlude the aorta with two clamps, the inferior clamp being placed at the point of aortic bifurcation. Which of the following vertebral bodies will lie posterior to the clamp at this level?

	L1
	T10
	L4
	L5
	L2

The aorta bifurcates at L4. An important landmark that is tested frequently.

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Which of the following statements relating to the greater omentum is false?

It is less well developed in children under 5.
It has no relationship to the lesser sac.
It contains the gastroepiploic arteries.
Has an attachment to the transverse colon.
It may be a site of metastatic disease in ovarian cancer.

It has no relationship to the lesser sac.

It is connected with the lesser sac and the transverse colon. This plane is entered when performing a colonic resection. It is a common site of metastasis in many visceral malignancies.

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A 48 year old man with newly diagnosed hypertension is found to have a phaeochromocytoma of the left adrenal gland and is due to undergo a laparoscopic left adrenalectomy. Which of the following structures is not directly related to the left adrenal gland?

	Crus of the diaphragm
	Lesser curvature of the stomach
	Kidney
	Pancreas
	Splenic artery

Lesser curvature of the stomach

The left adrenal gland is slightly larger than the right. It is crescent in shape and its concavity is adapted to the medial border of the upper part of the left kidney. The upper area is covered by peritoneum of the omental bursa which separates it from the cardia of the stomach

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Which of the following nerves innervates the long head of the biceps femoris muscle?

	Inferior gluteal nerve
	Tibial division of sciatic nerve
	Superior gluteal nerve
	Common peroneal division of sciatic nerve
	Obturator nerve

Tibial division of sciatic nerve

The short head of biceps femoris, which may occasionally be absent, is innervated by the common peroneal component of the sciatic nerve. The long head is innervated by the tibial division of the sciatic nerve.

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A 40 year old woman had the anterior lobe of the pituitary removed because of a tumour. Without postoperative supplements, which of the following could occur?

Failure to produce adequate amounts of thyroxine
Failure to produce parathyroid hormone in response to hypocalcaemia
Failure to secrete catecholamine in response to stress
Failure to secrete insulin in hyperglycemia
Inability to concentrate urine in response to water deprivation

Failure to produce adequate amounts of thyroxine

Its an anterior pituitary lesion and that is the reason thyroxine secretion is affected. ADH is released by the posterior pituitary.

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A 72 year old male with end stage critical ischaemia is undergoing an axillo-femoral bypass. What structure is not closely related to the axillary artery?

	Posterior cord of the brachial plexus
	Scalenus anterior muscle
	Pectoralis minor muscle
	Axillary vein
	Lateral cord of the brachial plexus

Scalenus anterior muscle

The axillary artery is the continuation of the subclavian artery. It is surrounded by the cords of the brachial plexus (from which they are named). The axillary vein runs alongside the axillary artery throughout its length.

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A 28 year old man is shot in the right chest and develops a right haemothorax necessitating a thoracotomy. The surgeons decide to place a vascular clamp across the hilum of the right lung. Which of the following structures will lie most anteriorly at this point?

	Thoracic duct
	Phrenic nerve
	Vagus nerve
	Pulmonary artery
	Pulmonary vein

Phrenic nerve

The phrenic nerve lies anteriorly at the root of the right lung.

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An 18 year old boy is undergoing an appendicectomy for appendicitis. At which of the following locations is the appendix most likely to be found?

	Pre ileal
	Pelvic
	Retrocaecal
	Post ileal
	None of the above

Retrocaecal

Most appendixes lie in the retrocaecal position. If a retrocaecal appendix is difficult to remove then mobilisation of the right colon significantly improves access.

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A 56 year old man is undergoing a pancreatectomy for carcinoma. During resection of the gland which of the following structures will the surgeon not encounter posterior to the pancreas itself?

	Left crus of the diaphragm
	Superior mesenteric vein
	Common bile duct
	Portal vein
	Gastroduodenal artery

Gastroduodenal artery

The gastroduodenal artery divides into the gastro-epiploic and pancreaticoduodenal arteries at the superior aspect of the pancreas.

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Which of the following bones is related to the cuboid’s distal articular surface?

	All metatarsals
	5th metatarsal
	Calcaneum
	Medial cuneiform
	3rd metatarsal

5th metatarsal

The cuboid is located at the lateral aspect of the foot between the calcaneus posteriorly and the 4th and 5th metatarsals distally.

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From which structure is the central tendon of the diaphragm derived?

	Septum transversum
	Pleuroperitoneal folds
	Diaphragmatic crura
	Dorsal mesocardium
	Oropharyngeal membrane

Septum transversum

The septum transversum is a thick ridge of mesodermal tissue in the developing embryo that separates the thoracic and abdominal cavities and forms the central tendon of the diaphragm

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Where does Stensens duct primarily open?

	Immediately lateral to the foramen caecum
	Floor of mouth
	Opposite the second molar tooth
	Opposite the fifth molar tooth
	Into the post nasal space

Opposite the second molar tooth

Stensens duct conveys secretions from the parotid gland and these enter the oral cavity at the level of the second molar tooth.

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Which of the following nerves is responsible for the innervation of the posterior belly of the digastric muscle?

	Facial nerve
	Hypoglossal nerve
	Trigeminal nerve
	Ansa cervicalis
	Mylohoid nerve

Facial nerve

The posterior belly of digastric is innervated by the facial nerve and the anterior belly by the mylohoid nerve.

Which of the following carpal bones is a sesamoid bone in the tendon of flexor carpi ulnaris?

	Triquetrum
	Lunate
	Pisiform
	Scaphoid
	Capitate

Pisiform

This small bone has a single articular facet. It projects from the triquetral bone at the ulnar aspect of the wrist where most regard it as a sesamoid bone lying within the tendon of flexor carpi ulnaris.

A 43 year old woman is due to undergo an axillary node clearance following a positive sentinel node biopsy. Which of the nerves below is at greatest risk?

	Accessory nerve
	Thoracodorsal
	Upper trunk of the brachial plexus
	Medial pectoral
	Axillary

Thoracodorsal

The long thoracic nerve is also at risk. The thoracodorsal nerve traverses the level 2 axillary nodes to supply latissimus dorsi and may be divided or damaged with diathermy.

A 70 year old man falls and fractures his scaphoid bone. The fracture is displaced and the decision is made to insert a screw to fix the fracture. Which of the following structures lies directly medial to the scaphoid?

	Lunate
	Pisiform
	Trapezoid
	Trapezium
	None of the above

Lunate

The lunate lies medially in the anatomical plane. Fractures of the scaphoid that are associated with high velocity injuries may cause associated lunate dislocation.

A 55 year old man is admitted with a brisk haematemesis. He is taken to the endoscopy department and an upper GI endoscopy is performed by the gastroenterologist. He identifies an ulcer on the posterior duodenal wall and spends an eternity trying to control the bleeding with all the latest haemostatic techniques. He eventually asks the surgeons for help. A laparotomy and anterior duodenotomy are performed, as the surgeon opens the duodenum a vessel is spurting blood into the duodenal lumen. From which of the following does this vessel arise? ``` Left gastric artery Common hepatic artery Right hepatic artery Superior mesenteric artery Splenic artery ```

Common hepatic artery The vessel will be the gastroduodenal artery, this arises from the common hepatic artery.

Which of the muscles listed below would be affected if the radial nerve were injured in a humeral shaft fracture? ``` Supinator Flexor digitorum profundus Brachialis Abductor pollicis brevis Abductor digiti minimi ```

Supinator

A 73 year old lady is hit by a car. She suffers a complex fracture of the distal aspect of her humerus with associated injury to the radial nerve. Which of the following movements will be most impaired as a result? ``` Elbow extension Elbow flexion Shoulder abduction Wrist extension None of the above ```

Wrist extension The triceps will not be affected so elbow extension will be preserved. Loss of wrist extension will be the most obvious effect.

Which of the following is not a content of the rectus sheath? ``` Pyramidalis Superior epigastric artery Inferior epigastric vein Internal iliac artery Rectus abdominis ```

Internal iliac artery The rectus sheath also contains: superior epigastric vein inferior epigastric artery

Which of the following vessels does not drain directly into the inferior vena cava? ``` Superior mesenteric vein Right common iliac Right hepatic vein Left hepatic vein Right testicular vein ```

Superior mesenteric vein The superior mesenteric vein drains into the portal vein. The right and left hepatic veins drain into it directly, this can account for major bleeding in more extensive liver shearing type injuries.

A 17 year old male has a suspected testicular torsion and the scrotum is to be explored surgically. The surgeon incises the skin and then the dartos muscle. What is the next tissue layer that will be encountered during the dissection? ``` Visceral layer of the tunica vaginalis Cremasteric fascia Parietal layer of the tunica vaginalis External spermatic fascia Internal spermatic fascia ```

External spermatic fascia The layers that will be encountered are (in order): 1. Skin 2. Dartos fascia and muscle 3. External spermatic fascia 4. Cremasteric muscle and fascia 5. Internal spermatic fascia 6. Parietal layer of the tunica vaginalis

A well toned weight lifter attends clinic reporting weakness of his left arm. There is weakness of flexion and supination of the forearm. Which of the following nerves is likely to have been affected? ``` Axillary Suprascapular Median Radial Musculocutaneous ```

Musculocutaneous Musculocutaneous nerve compression due to entrapment of the nerve between biceps and brachialis. Elbow flexion and supination of the arm are affected. This is a rare isolated injury.

A 25 year old man is stabbed in the groin and the area, which lies within the femoral triangle is explored. Which structure forms the lateral wall of the femoral triangle? ``` Adductor longus Pectineus Adductor magnus Sartorius Conjoint tendon ```

Sartorius The sartorius forms the lateral wall of the femoral triangle

An 18 year old man develops a severe spreading sepsis of the hand. The palm is explored surgically and the flexor digiti minimi brevis muscle is mobilised to facilitate drainage of the infection. Which of the following structures is not closely related to this muscle? ``` The hook of hamate Median nerve Superficial palmar arterial arch Digital nerves arising from the ulnar nerve None of the above ```

Median nerve The flexor digiti minimi brevis originates from the Hamate, on its under- surface lie the ulnar contribution to the superficial palmar arterial arch and digital nerves derived from the ulnar nerve. The median nerve overlies the flexor tendons.

A 19 year old man undergoes an open inguinal hernia repair. The cord is mobilised and the deep inguinal ring identified. Which of the following structures forms its lateral wall? ``` External oblique aponeurosis Transversalis fascia Conjoint tendon Inferior epigastric artery Inferior epigastric vein ```

Transversalis fascia The transversalis fascia forms the superolateral edge of the deep inguinal ring. The epigastric vessels form its inferomedial wall.

A 22 year old man develops an infection in the pulp of his little finger. What is the most proximal site to which this infection may migrate? ``` The metacarpophalangeal joint The distal interphalangeal joint The proximal interphalangeal joint Proximal to the flexor retinaculum Immediately distal to the carpal tunnel ```

Proximal to the flexor retinaculum The 5th tendon sheath extends from the little finger to the proximal aspect of the carpal tunnel. This carries a significant risk of allowing infections to migrate proximally.

Which of the following muscles is not innervated by the deep branch of the ulnar nerve? ``` Adductor pollicis Hypothenar muscles All the interosseous muscles Opponens pollicis Third and fourth lumbricals ```

Opponens pollicis

During an inguinal hernia repair the surgeon identifies a small nerve whilst mobilising the cord structures at the level of the superficial inguinal ring. Which nerve is this most likely to be? ``` Subcostal Iliohypogastric Ilioinguinal Obturator Pudendal ```

Ilioinguinal The ilioinguinal nerve passes through the superfical inguinal ring and is routinely encountered when exploring the inguinal canal during hernia surgery. The iliohypogastric nerve pierces the aponeurosis of the external oblique muscle superior to the superficial inguinal ring.

A 25 year old man undergoes an excision of a pelvic chondrosarcoma, during the operation the obturator nerve is sacrificed. Which of the following muscles is least likely to be affected as a result? ``` Adductor longus Pectineus Adductor magnus Sartorius Gracilis ```

Sartorius Sartorius is supplied by the femoral nerve. In approximately 20% of the population, pectineus is supplied by the accessory obturator nerve. Adductor magnus has a composite supply from the obturator and sciatic nerves.

During an arch aortogram the brachiocephalic artery is entered with an angiography catheter. The radiologist continues to advance the catheter. Into which of the following vessels is it likely to enter? ``` Left subclavian artery Left axillary artery Right subclavian artery Right axillary artery None of the above ```

Right subclavian artery The axillary artery is a branch of the subclavian artery and although developmental anomalies may occur they are rare. The catheter may also enter the right carotid. There is no brachiocephalic artery on the left side.

Which of the following structures lie between the lateral and medial heads of the triceps muscle? ``` Radial nerve Median nerve Ulnar nerve Axillary nerve Medial cutaneous nerve of the forearm ```

Radial nerve The radial nerve runs in its groove on between the two heads.

Into which of the following structures does the superior part of the fibrous capsule of the shoulder joint insert? ``` The surgical neck of the humerus The body of the humerus The bicipital groove Immediately distal to the greater tuberosity The anatomical neck of the humerus ```

The anatomical neck of the humerus The shoulder joint is a shallow joint, hence its great mobility. However, this comes at the expense of stability. The fibrous capsule attaches to the anatomical neck superiorly and the surgical neck inferiorly

What is the lymphatic drainage of the membranous urethra? ``` Deep inguinal nodes Superficial inguinal nodes Internal iliac nodes External iliac nodes Para-aortic nodes ```

Internal iliac nodes The prostatic and membranous urethra drain to the internal iliac nodes.

A 34 year old lady presents with symptoms of faecal incontinence. Ten years previously she gave birth to a child by normal vaginal delivery. Injury to which of the following nerves is most likely to account for this process? ``` Genitofemoral Ilioinguinal Pudendal Hypogastric autonomic nerve Obturator ```

Pudendal Damage to the pudendal nerve is classically associated with faecal incontinence and it is for this reason that sacral neuromodulation is a popular treatment for the condition. Injury to the hypogastric autonomic nerves is an aetiological factor in the development of constipation.

During a difficult thyroidectomy haemorrhage is noted from the thyroidea ima vessel. From which structure does this vessel usually arise? ``` External carotid artery Internal carotid artery Brachiocephalic artery Axillary artery Superior thyroid artery ```

Brachiocephalic artery This accessory vessel which usually lies at the inferior aspect of the gland is derived either from the brachiocephalic artery or the arch of the aorta.

A 49 year old man undergoes a low anterior resection for cancer. He is assessed in the outpatient clinic post operatively. His wounds are well healed. However, he complains of impotence. Which of the following best explains this problem? ``` Sciatic nerve injury Damage to the internal iliac artery Damage to the nervi erigentes Damage to the vas Damage to the genitofemoral nerve ```

Damage to the nervi erigentes The penis takes autonomic nerves from the nervi erigentes that lie near the seminal vesicles. These may be compromised by direct surgical trauma (such as use of diathermy in this area) and also by radiotherapy that is used in these patients pre operatively. The result is that up to 50% of patients may develop impotence following rectal cancer surgery.

The cephalic vein pierces the clavipectoral fascia to terminate in which of the veins listed below? ``` External jugular Axillary Internal jugular Azygos Brachial ```

Axillary

A 43 year old lady develops a cerebello-pontine angle lesion. Which of the nerves listed below is likely to be affected first? ``` CN X CN III CN V CN IX CN XII ```

CN V The most likely lesion to occur in the cerebello-pontine angle is an acoustic neuroma. The trigeminal nerve has a broad base and involvement of at least part of this nerve is the most likely initial finding

Which of the following is not a branch of the abdominal aorta? ``` Inferior mesenteric artery Inferior phrenic artery Superior mesenteric artery Superior phrenic artery Renal artery ```

Superior phrenic artery The superior phrenic artery branches from the aorta in the thorax

A 40 year old lady presents with varicose veins, these are found to originate from the short saphenous vein. As the vein is mobilised which structure is at greatest risk of injury? ``` Sciatic nerve Sural nerve Common peroneal nerve Tibial nerve Popliteal artery ```

Sural nerve The sural nerve is closely related and damage to this structure is a major cause of litigation. The other structures may all be injured but the risks are lower.

A 23 year old man is admitted with a suspected ureteric colic. A KUB style x-ray is obtained. In which of the following locations is the stone most likely to be visualised? The tips of the transverse processes between L2 and L5 The tips of transverse processes between T10-L1 At the crest of the ilium Over the S3 foramina Over the sacrococcygeal joint

The tips of the transverse processes between L2 and L5 The ureter lies anterior to L2 to L5 and stones may be visualised at these points, they may also be identified over the sacro-iliac joints.