EMRCS ANATOMY 8 Flashcards
A 72 year old man with non reconstructible arterial disease is undergoing an above knee amputation. The posterior compartment muscles are divided. Which of the following muscles does not lie in the posterior compartment of the thigh?
Biceps femoris Quadriceps femoris Semitendinosus Semimembranosus None of the above
Quadriceps femoris
The quadriceps femoris lies in the anterior compartment.
A woman develops winging of the scapula following a Patey mastectomy. What is the most likely cause?
Division of pectoralis minor to access level 3 axillary nodes Damage to the brachial plexus during axillary dissection Damage to the long thoracic nerve during axillary dissection Division of the thoracodorsal trunk during axillary dissection Damage to the thoracodorsal trunk during axillary dissection
Damage to the long thoracic nerve during axillary dissection
The serratus anterior muscle is supplied by the long thoracic nerve which runs along the surface of serratus anterior and is liable to injury during nodal dissection. Although pectoralis minor is divided during a Patey mastectomy (now seldom performed) it is rare for this alone to produce winging of the scapula.
In a patient with an ectopic kidney where is the adrenal gland most likely to be located?
In the pelvis On the contralateral side In its usual position Superior to the spleen It will be absent
In its usual position
Because the kidney is present, rather than absent, the adrenal will usually develop and in the normal location.
Which of the following structures is not closely related to the posterior tibial artery?
Soleus posteriorly Tibial nerve laterally Deep peroneal nerve laterally Flexor hallucis longus postero-inferiorly Popliteus
Deep peroneal nerve laterally
The deep peroneal nerve lies in the anterior compartment. The tibial nerve lies medially. At its termination it lies deep to the flexor retinaculum. The tibial nerve lies medial to the popliteal vessels but lateral to the posterior tibial artery.
Which cranial nerve provides general sensation to the anterior two thirds of the tongue?
Facial Trigeminal Hypoglossal Vagus Glossopharyngeal
Trigeminal
Taste to the anterior two thirds of the tongue is supplied by the facial nerve, the trigeminal supplies general sensation, this is mediated by the mandibular branch of the trigeminal nerve (via the lingual nerve).
Which of the following is not closely related to the capitate bone?
Lunate bone Scaphoid bone Ulnar nerve Hamate bone Trapezoid bone
Ulnar nerve
The ulnar nerve and artery lie adjacent to the pisiform bone. The capitate bone articulates with the lunate, scaphoid, hamate and trapezoid bones, which are therefore closely related to it.
A 62 year old male complains of back pain. He has had a recent fall. Walking causes pain of the left lower leg. On examination, he is noted to have reduced sensation over the knee. Which of the spinal levels listed below is most likely to have been affected?
L1 L3 L2 L4 L5
L3
Sensation over the knee is equivalent to the L3 dermatome. The four nerves involved include the infrapatellar branch of the saphenous nerve, the lateral cutaneous nerve of the thigh, anterior cutaneous nerve of the thigh (both lateral and medial branches).
Which of the following statements relating to the tympanic membrane is false?
The umbo marks the point of attachment of the handle of the malleus to the tympanic membrane The lateral aspect of the tympanic membrane is lined by stratified squamous epithelium The chorda tympani nerve runs medial to the pars tensa The medial aspect of the tympanic membrane is lined by mucous membrane The tympanic membrane is approximately 1cm in diameter
The chorda tympani nerve runs medial to the pars tensa
The chorda tympani runs medially to the pars flaccida.
Which nerve supplies sensation to the nail bed of the index finger?
Median Ulnar Radial Musculocutaneous Axillary
Median
An injury to the spinal accessory nerve will have the greatest effect on which of the following movements?
Lateral rotation of the arm Adduction of the arm at the glenohumeral joint Protraction of the scapula Upward rotation of the scapula Depression of the scapula
Upward rotation of the scapula
The spinal accessory nerve innervates trapezius. The entire muscle will retract the scapula. However, its upper and lower fibres act together to upwardly rotate it.
Which of the following is not contained within the middle mediastinum?
Main bronchi Arch of the azygos vein Thoracic duct Pericardium Aortic root
Thoracic duct
The thoracic duct lies within the posterior and superior mediastinum.
A 55 year old man is due to undergo a radical prostatectomy for carcinoma of the prostate gland. Which of the following vessels directly supplies the prostate?
External iliac artery Common iliac artery Internal iliac artery Inferior vesical artery None of the above
Inferior vesical artery
The arterial supply to the prostate gland is from the inferior vesical artery, it is a branch of the prostatovesical artery. The prostatovesical artery usually arises from the internal pudendal and inferior gluteal arterial branches of the internal iliac artery.
Which nerve directly innervates the sinoatrial node?
Superior cardiac nerve Right vagus nerve Left vagus nerve Inferior cardiac nerve None of the above
None of the above
No single one of the above nerves is responsible for direct cardiac innervation (which those who have handled the heart surgically will appreciate).
The heart receives its nerves from the superficial and deep cardiac plexuses
A 56 year old man suddenly develops severe back pain. His pain has a radicular pattern. On examination, he is unable to extend his great toe. Which of the spinal levels listed below is most likely to have been affected?
L5 L4 L3 L2 L1
L5
Extensor hallucis longus is derived from L5 and loss of EHL function is a useful test to determine whether this level is involved.
A 30 year old man presents with back pain and the surgeon tests the ankle reflex. Which of the following nerve roots are tested in this manoeuvre?
S3 and S4 L4 and L5 L3 and L4 S1 and S2 S4 only
S1 and S2
The ankle reflex is elicited by tapping the Achilles tendon with a tendon hammer. It tests the S1 and S2 nerve roots.
Which of the following structures is not closely related to the piriformis muscle?
Superior gluteal nerve Sciatic nerve Inferior gluteal artery Inferior gluteal nerve Medial femoral circumflex artery
Medial femoral circumflex artery
The piriformis muscle is an important anatomical landmark in the gluteal region. The following structures are closely related:
Sciatic nerve
Inferior gluteal artery and nerve
Superior gluteal artery and nerve
Which of the following structures accompanies the posterior interventricular artery within the posterior interventricular groove?
Great cardiac vein Middle cardiac vein Small cardiac vein Anterior cardiac vein Coronary sinus
Middle cardiac vein
An 18 year old male presents to casualty with a depressed skull fracture. This is managed surgically. Over the next few days he complains of double vision on walking down stairs and reading. On testing ocular convergence, the left eye faces downwards and medially, but the right side does not do so. Which of the nerves listed below is most likely to be responsible?
Facial Oculomotor Abducens Trochlear Trigeminal nerve
Trochlear
The trochlear nerve has a relatively long intracranial course and this makes it vulnerable to injury in head trauma. Head trauma is the commonest cause of an acute fourth nerve palsy. A 4th nerve palsy is the commonest cause of a vertical diplopia. The diplopia is at its worst when the eye looks medially which it usually does as part of the accommodation reflex when walking down stairs.
A 77 year old man with symptoms of intermittent claudication is due to have his ankle brachial pressure indices measured. The dorsalis pedis artery is impalpable. Which of the following tendinous structures lies medial to it, that may facilitate its identification?
Extensor digitorum longus tendon Peroneus tertius tendon Extensor hallucis longus tendon Extensor digitorum brevis tendon Flexor digitorum longus tendon
Extensor hallucis longus tendon
The extensor hallucis longus tendon lies medial to the dorsalis pedis artery.
A 28 year teacher reports difficulty with writing. There is no sensory loss. She is known to have an aberrant Gantzer muscle. Which of the following nerves has been affected?
Posterior interosseous Anterior interosseous Median Ulnar Musculocutaneous
Anterior interosseous
Anterior interosseous lesions occur due to fracture, or rarely due to compression. The Gantzer muscle is an aberrant accessory of the flexor pollicis longus and is a risk factor for anterior interosseous nerve compression. Remember loss of pincer grip and normal sensation indicates an interosseous nerve lesion.
