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.
What is the level of the hyoid bone?
C1 C2 C3 C4 C5
C3
A 23 year old man falls over whilst intoxicated and a shard of glass transects his median nerve at the proximal border of the flexor retinaculum. His tendons escape injury. Which of the following features is least likely to be present?
Weakness of thumb abduction Loss of sensation on the dorsal aspect of the thenar eminence Loss of power of opponens pollicis Adduction and lateral rotation of the thumb at rest Loss of power of abductor pollicis brevis
Loss of sensation on the dorsal aspect of the thenar eminence
The median nerve may be injured proximal to the flexor retinaculum. This will result in loss of abductor pollicis brevis, flexor pollicis brevis, opponens pollicis and the first and second lumbricals. When the patient is asked to close the hand slowly there is a lag of the index and middle fingers reflecting the impaired lumbrical muscle function. The sensory changes are minor and do not extend to the dorsal aspect of the thenar eminence
The following muscles are supplied by the recurrent laryngeal nerve except:
Transverse arytenoid Posterior crico-arytenoid Cricothyroid Oblique arytenoid Thyroarytenoid
Cricothyroid
The external branch of the superior laryngeal nerve innervates the cricothyroid muscle.
From which embryological structure is the ureter derived?
Uranchus Cloaca Vitello-intestinal duct Mesonephric duct None of the above
Mesonephric duct
The ureter develops from an outpouching that arises from the mesonephric duct.
A 16 year old boy is hit by a car and sustains a blow to the right side of his head. He is initially conscious but on arrival in the emergency department is comatose. On examination his right pupil is fixed and dilated. The neurosurgeons plan immediate surgery. What type of initial approach should be made?
Left parieto-temporal craniotomy Right parieto-temporal craniotomy Posterior fossa craniotomy Left parieto-temporal burr holes None of the above
Right parieto-temporal craniotomy
A unilateral dilated pupil is a classic sign of transtentorial herniation. The medial aspect of the temporal lobe (uncus) herniates across the tentorium and causes pressure on the ipsilateral oculomotor nerve, interrupting parasympathetic input to the eye and resulting in a dilated pupil. In addition the brainstem is compressed. As the ipsilateral oculomotor nerve is being compressed, craniotomy (rather than Burr Holes) should be made on the ipsilateral side.
Which of the following relationship descriptions regarding the scalene muscles is incorrect?
The brachial plexus passes anterior to the middle scalene muscle The phrenic nerve lies anterior to the anterior scalene muscle The subclavian artery passes posterior to the middle scalene The subclavian vein lies anterior to the anterior scalene muscle at the level of the first rib The anterior scalene inserts into the first rib
The subclavian artery passes posterior to the middle scalene
The subclavian artery passes anterior to the middle scalene.
A 56 year old man is having a long venous line inserted via the femoral vein into the right atrium for CVP measurements. The catheter is advanced through the IVC. At which of the following levels does this vessel enter the thorax?
L2 T10 L1 T8 T6
T8
The IVC passes through the diaphragm at T8.
A 23 year old man falls and injures his hand. There are concerns that he may have a scaphoid fracture as there is tenderness in his anatomical snuffbox on clinical examination. Which of the following forms the posterior border of this structure?
Basilic vein Radial artery Extensor pollicis brevis Abductor pollicis longus Extensor pollicis longus
Extensor pollicis longus
It’s boundaries are extensor pollicis longus, medially (posterior border) and laterally (anterior border) by the tendons of abductor pollicis longus and extensor pollicis brevis.
Which of the following structures attaches periosteum to bone?
Sharpeys fibres Peripheral lamellae Elastic fibres Fibrolamellar bundles Purkinje fibres
Sharpeys fibres
Periosteum is attached to bone by strong collagenous fibers called Sharpey’s fibres, which extend to the outer circumferential and interstitial lamellae. It also provides an attachment for muscles and tendons.
A 62 year old man is undergoing a left hemicolectomy for carcinoma of the descending colon. The registrar commences mobilisation of the left colon by pulling downwards and medially. Blood soon appears in the left paracolic gutter. The most likely source of bleeding is the:
Marginal artery Left testicular artery Spleen Left renal vein None of the above
Spleen
The spleen is commonly torn by traction injuries in colonic surgery
A 22 year man is shot in the groin. On examination, he has weak hip flexion, weak knee extension, and impaired quadriceps tendon reflex, as well as sensory deficit in the anteromedial aspect of the thigh. Which structure has been affected?
Femoral nerve Sciatic nerve Superior gluteal nerve Ilioinguinal nerve Genitofemoral nerve
Femoral nerve
This is a classical description of a femoral nerve injury.
A man is undergoing excision of a sub mandibular gland. As the gland is mobilised, a vessel is injured lying between the gland and the mandible. Which of the following is this vessel most likely to be?
Lingual artery Occipital artery Superior thyroid artery Facial artery External jugular vein
Facial artery
The facial artery lies between the gland and mandible and is often ligated during excision of the gland. The lingual artery may be encountered but this is usually later in the operative process as Whartons duct is mobilised.
The integrity of which muscle is assessed by the Trendelenburg test?
Sartorius Quadratus femoris Semimembranosus Gluteus medius Piriformis
Gluteus medius
A 52 year old female renal patient needs a femoral catheter to allow for haemodialysis. Which of the structures listed below is least likely to be encountered during its insertion?
Great saphenous vein Deep circumflex iliac artery Superficial circumflex iliac artery Femoral vein Femoral branch of the genitofemoral nerve
Deep circumflex iliac artery
Femoral access catheters are typically inserted in the region of the femoral triangle. Therefore the physician may encounter the femoral, vein, nerve, branches of the femoral artery and tributaries of the femoral vein. The deep circumflex iliac artery arises above the inguinal ligament and is therefore less likely to be encountered than the superficial circumflex iliac artery which arises below the inguinal ligament.
A 44 year old lady who works as an interior decorator has undergone a mastectomy and axillary node clearance to treat breast cancer. Post operatively, she comments that her arm easily becomes fatigued when she is painting walls. What is the most likely explanation?
Injury to the axillary nerve Injury to the long thoracic nerve Injury to the intercostobrachial nerve Injury to the thoracodorsal nerve Injury to the median pectoral nerve
Injury to the thoracodorsal nerve
The most likely explanation for this is that the thoracodorsal nerve has been injured. This will result in atrophy of latissimus dorsi and this will become evident with repetitive arm movements where the arm is elevated and moving up and down (such as in painting).
A 53 year old man with a chronically infected right kidney is due to undergo a nephrectomy. Which of the following structures would be encountered first during a posterior approach to the hilum of the right kidney?
Right renal artery Ureter Right renal vein Inferior vena cava Right testicular vein
Ureter
The ureter is the most posterior structure at the hilum of the right kidney and would therefore be encountered first during a posterior approach.
The common peroneal nerve, or its branches, supply the following muscles except:
Peroneus longus Tibialis anterior Extensor hallucis longus Flexor digitorum brevis Extensor digitorum longus
Flexor digitorum brevis
Flexor digitorum is supplied by the tibial nerve.
A 28 year old man is stabbed outside a nightclub in the upper arm. The median nerve is transected. Which of the following muscles will demonstrate impaired function as a result?
Palmaris brevis Second and third interossei Adductor pollicis Abductor pollicis longus Abductor pollicis brevis
Abductor pollicis brevis
The median nerve innervates all the short muscles of the thumb except the adductor and the deep head of the short flexor. Palmaris and the interossei are innervated by the ulnar nerve.
A 22 year old man sustains a blow to the side of his head with a baseball bat during a fight. He is initially conscious. However, he subsequently loses consciousness and then dies. Post mortem examination shows an extradural haematoma. The most likely culprit vessel is a branch of which of the following?
Middle cerebral artery Internal carotid artery Anterior cerebral artery Maxillary artery Mandibular artery
Maxillary artery
The middle meningeal artery is the most likely source of the extradural haematoma in this setting. It is a branch of the maxillary artery.
A 72 year old man with carcinoma of the lung is undergoing a left pneumonectomy. The left main bronchus is divided. Which of the following thoracic vertebrae lies posterior to this structure?
T3 T7 T6 T10 T1
T6
The left main bronchus lies at T6.
Which of the following regions of the male urethra is entirely surrounded by Bucks fascia?
Preprostatic part Prostatic part Membranous part Spongiose part None of the above
Spongiose part
The spongiose part of the urethra is contained wholly within Bucks fascia.
Which of the following statements relating to the knee joint is false?
It is the largest synovial joint in the body When the knee is fully extended all ligaments of the knee joint are taut Rupture of the anterior cruciate ligament may result in haemarthrosis The posterior aspect of the patella is extrasynovial The joint is innervated by the femoral, sciatic and obturator nerves
The posterior aspect of the patella is extrasynovial
The posterior aspect is intrasynovial and the knee itself comprises the largest synovial joint in the body
In the distal third of the upper arm, where is the musculocutaneous nerve located?
Between the biceps brachii and brachialis muscles Between the brachialis and brachioradialis muscles Between the brachioradialis and triceps muscles Between the brachialis and triceps muscles Between the humerus and brachialis muscles
Between the biceps brachii and brachialis muscles
The musculocutaneous nerve lies between the biceps and brachialis muscles
A 48 year old lady is undergoing a left sided adrenalectomy for an adrenal adenoma. The superior adrenal artery is injured and starts to bleed, from which of the following does this vessel arise?
Left renal artery Inferior phrenic artery Aorta Splenic None of the above
Inferior phrenic artery
The superior adrenal artery is a branch of the inferior phrenic artery.
Which of the following does not exit the pelvis through the greater sciatic foramen?
Superior gluteal artery Internal pudendal vessels Sciatic nerve Obturator nerve Inferior gluteal nerve
Obturator nerve
The obturator nerve exits through the obturator foramen.
Which statement is false about the foramina of the skull?
The hypoglossal canal transmits the hypoglossal nerve The foramen spinosum is at the base of the medial pterygoid plate. The jugular foramen transmits the accessory nerve The foramen lacerum is located in the sphenoid bone The stylomastoid foramen transmits the facial nerve
The foramen spinosum is at the base of the medial pterygoid plate.
An 80 year old lady with a caecal carcinoma is undergoing a right hemicolectomy performed through a transverse incision. The procedure is difficult and the incision is extended medially by dividing the rectus sheath. Brisk arterial haemorrhage ensues. From which of the following does the damaged vessel originate?
Internal iliac artery External iliac artery Superior vesical artery Inferior vesical artery None of the above
External iliac artery
The vessel damaged is the epigastric artery. This originates from the external iliac artery
A 73 year old man has a large abdominal aortic aneurysm. During a laparotomy for planned surgical repair the surgeons find the aneurysm is far more proximally located and lies near the origin of the SMA. During the dissection a vessel lying transversely across the aorta is injured. What is this vessel most likely to be?
Left renal vein Right renal vein Inferior mesenteric artery Ileocolic artery Middle colic artery
Left renal vein
The left renal vein runs across the surface of the aorta and may require deliberate ligation during juxtarenal aneurysm repair.
Which of the following is not a branch of the posterior cord of the brachial plexus?
Thoracodorsal nerve Axillary nerve Radial nerve Lower subscapular nerve Musculocutaneous nerve
Musculocutaneous nerve
The musculocutaneous nerve is a branch off the lateral cord.
A 18 year old man presents with an indirect inguinal hernia and undergoes surgery. The deep inguinal ring is exposed and held with a retractor at its medial aspect. Which structure is most likely to lie under the retractor?
Ureter Inferior epigastric artery Internal iliac vein Femoral artery Lateral border of rectus abdominis
Inferior epigastric artery
The deep inguinal ring is closely related to the inferior epigastric artery. The inferior epigastric artery forms part of the structure referred to as Hesselbach’s triangle.
A 73 year old man presents with a tumour at the tip of his tongue. To which of the following regions will the tumour initially metastasise?
Sub mental nodes Ipsilateral deep cervical nodes Tonsil Ipsilateral superficial cervical nodes Contralateral deep cervical nodes
Sub mental nodes
Lymphatics from the tip of the tongue usually pass to the sub mental nodes and from there to the deep cervical nodes
