emrcs anatomy Flashcards
Which of the structures listed below are most closely related to the axillary nerve within the quadrangular space?
Posterior circumflex humeral vessels Axillary artery Anterior circumflex humeral vessels Radial artery Acromiothoracic artery
Posterior circumflex humeral vessels
The posterior circumflex humeral vessels which are branches of the axillary artery are related to the axillary nerve within the quadrangular space.
A 43 year old lady is undergoing a total thyroidectomy for an extremely large goitre. The surgeons decide that access may be improved by division of the infra hyoid strap muscles. At which of the following sites should they be divided?
In their upper half In their lower half In the middle At their origin from the hyoid At the point of their insertion
In their upper half
Should the strap muscles require division during surgery they should be divided in their upper half. This is because their nerve supply from the ansa cervicalis enters in their lower half.
A 7 year old boy presents with right iliac fossa pain and there is a clinical suspicion that appendicitis is present. From which of the following embryological structures is the appendix derived?
Vitello-intestinal duct Uranchus Foregut Hindgut Midgut
Midgut
It is derived from the midgut which is why early appendicitis may present with periumbilical pain.
Where are the reticulo-endothelial cells concentrated within the spleen?
Within the capsule Within the red pulp Within the trabeculae Within the white pulp Within the splenic cords
Within the white pulp
The reticuloendothelial cells are concerned with the immune functions of the spleen and these are therefore concentrated in the white pulp.
A 22 year old women has recently undergone a surgical excision of the submandibular gland. She presents to the follow up clinic with a complaint of tongue weakness on the ipsilateral side to her surgery. Which nerve has been damaged?
Hypoglossal nerve Lingual nerve Inferior alveolar nerve Facial nerve Lesser petrosal nerve
Hypoglossal nerve
Three cranial nerves may be injured during submandibular gland excision.
Marginal mandibular branch of the facial nerve
Lingual nerve
Hypoglossal nerve
Hypoglossal nerve damage may result in paralysis of the ipsilateral aspect of the tongue. The nerve itself lies deep to the capsule surrounding the gland and should not be injured during an intracapsular dissection. The lingual nerve is probably at greater risk of injury. However, the effects of lingual nerve injury are sensory rather than motor.
You decide to take an arterial blood gas from the femoral artery. Where should the needle be inserted to gain the sample?
1-2 cm inferiorly to the mid point of the inguinal ligament 1-2cm inferiorly to the mid inguinal point 2cm inferomedially to the pubic tubercle 2cm superomedially to the pubic tubercle 3cm inferolaterally to the deep inguinal rin
1-2cm inferiorly to the mid inguinal point
The mid inguinal point is midway between the anterior superior iliac spine and the symphysis pubis
The mid inguinal point is the surface marking for the femoral artery.
A 67 year old man undergoes a carotid endarterectomy and seems to recover well following surgery. When he is reviewed on the ward post operatively he complains that his voice is hoarse. What is the most likely cause?
Damage to the accessory nerve Damage to the cervical plexus Damage to the glossopharyngeal nerve Damage to the hypoglossal nerve Damage to the vagus
Damage to the vagus
Many of these nerves are at risk of injury during carotid surgery. However, only damage to the vagus would account for a hoarse voice.
A 25 year old man has an inguinal hernia, which of the following structures must be divided (at open surgery) to gain access to the inguinal canal?
Transversalis fascia External oblique aponeurosis Conjoint tendon Rectus abdominis Inferior epigastric artery
External oblique aponeurosis
This question is asking what structure forms the anterior wall of the inguinal canal. The anterior wall is formed by the external oblique aponeurosis. Once this is divided the canal is entered, the cord can be mobilised and a hernia repair performed. The transversalis fascia and conjoint tendons form the posterior wall and would not routinely be divided to gain access to the inguinal canal itself.
Which muscle initiates abduction of the shoulder?
Infraspinatus Latissimus dorsi Supraspinatus Deltoid Teres major
Supraspinatus
The intermediate portion of the deltoid muscle is the chief abductor of the humerus. However, it can only do this after the movement has been initiated by supraspinatus. Damage to the tendon of supraspinatus is a common form of rotator cuff disease.
Which of the following nerves is most commonly damaged during a superficial parotidectomy?
Greater auricular Facial Greater occipital Accessory Opthalmic branch of the trigeminal
Greater auricular
The greater auricular nerve and in particular its lobular branch is commonly injured in parotid surgery and consent usually makes particular reference to this. In a superficial parotidectomy, the facial nerve should not be injured and this is less common than a greater auricular nerve injury.
A 34 year old man is shot in the postero- inferior aspect of his thigh. Which of the following lies at the most lateral aspect of the popliteal fossa?
Popliteal artery Popliteal vein Common peroneal nerve Tibial nerve Small saphenous vein
Common peroneal nerve
The contents of the popliteal fossa are (from medial to lateral): Popliteal artery Popliteal vein Tibial nerve Common peroneal nerve
The sural nerve is a branch of the tibial nerve and usually arises at the inferior aspect of the popliteal fossa. However, its anatomy is variable
A 67 year old man has an abdominal aortic aneurysm which displaces the left renal vein. Which branch of the aorta is most likely to be affected at this level?
Inferior mesenteric artery Superior mesenteric artery Coeliac axis Testicular artery None of the above
Superior mesenteric artery
The left renal vein lies behind of the SMA as it branches off the aorta. Whilst juxtarenal AAA may sometimes require the division of the left renal vein, direct involvement of the SMA may require a hybrid surgical bypass and subsequent endovascular occlusion.
An 21 year old man undergoes an uncomplicated tonsillectomy for recurrent attacks of tonsillitis. Post operatively he complains of otalgia. Which nerve is responsible?
Trigeminal Hypoglossal Glossopharyngeal Facial Vagus
Glossopharyngeal
The glossopharyngeal nerve supplies this area and the ear and otalgia may be the result of referred pain.
A 12 year old boy undergoes surgery for recurrent mastoid infections. Post operatively he complains of an altered taste sensation. Which of the following nerves has been injured?
Glossopharyngeal Greater petrosal Olfactory Trigeminal Chorda tympani
Chorda tympani
The chorda tympani branch of the facial nerve passes forwards through itrs canaliculus into the middle ear, and crosses the medial aspect of the tympanic membrane. It then passes antero-inferiorly in the infratemporal fossa. It distributes taste fibres to the anterior two thirds of the tongue.
What is the origin of the superior gluteal artery?
Internal iliac artery External iliac artery Femoral artery Common iliac artery Circumflex femoral artery
Internal iliac artery
The inferior gluteal artery arises from the anterior trunk of the internal iliac artery
The superior gluteal artery arises from the posterior trunk of the internal iliac artery
The first root of the brachial plexus commonly arises at which of the following levels?
C6 C5 C3 C2 C8
C5
It begins at C5 and has 5 roots. It ends with a total of 15 nerves of these 5 are the main nerves to the upper limb (axillary, radial, ulnar, musculocutaneous and median)
What is the anatomical level of the transpyloric plane?
T11 T12 L1 L4 T10
L1
Transpyloric plane
Level of the body of L1
Pylorus stomach Left kidney hilum (L1- left one!) Right hilum of the kidney (1.5cm lower than the left) Fundus of the gallbladder Neck of pancreas Duodenojejunal flexure Superior mesenteric artery Portal vein Left and right colic flexure Root of the transverse mesocolon 2nd part of the duodenum Upper part of conus medullaris Spleen
Which of the nerves listed below is responsible for the innervation of gluteus maximus?
Inferior gluteal nerve Superior gluteal nerve Posterior femoral cutaneous nerve Sciatic nerve Perineal nerve
Inferior gluteal nerve
Superior gluteal nerve
Arises from dorsal surface of the sacral plexus (L4, 5, S1)
Passes into gluteal region together with superior gluteal vessels
Supplies gluteus medius and minimus
Inferior gluteal nerve
Arises from dorsal surface of sacral plexus (L5, S1 and S2)
Runs medial to the posterior femoral cutaneous nerve
Enters gluteal region at inferior border of piriformis
Supplies gluteus maximus
When the brachial plexus is injured in the axilla as a result of a crutch palsy, which of the nerves listed is most commonly affected?
Thoracodorsal nerve Suprascapular nerve Radial nerve Ulnar nerve Long thoracic nerve
Radial nerve
The radial nerve is most commonly injured and results in a wrist drop. The ulnar nerve arises from the medial cord and is rarely affected as a result of this injury mechanism
During a neck dissection, a nerve is noted to pass posterior to the medial aspect of the first rib. Which of the nerves listed below is this most likely to be?
Medial cord of the brachial plexus Long thoracic nerve Nerve to subclavius Medial pectoral nerve Phrenic nerve
Phrenic nerve
The key point is that the phrenic nerve runs posterior to the medial aspect of the first rib. Superiorly, it lies on the surface of scalenus anterior.
A 35 year old man falls and sustains a fracture to the medial third of his clavicle. Which vessel is at greatest risk of injury?
Subclavian vein Subclavian artery External carotid artery Internal carotid artery Vertebral artery
Subclavian vein
The subclavian vein lies behind subclavius and the medial part of the clavicle. It rests on the first rib, below and in front of the third part of the subclavian artery, and then on scalenus anterior which separates it from the second part of the artery (posteriorly).
The pudendal canal is a fascial canal located on the lateral wall of the ischioanal fossa. In this location, it lies on the inferior border of which of the following muscles?
Coccygeus Obturator internus Pubococcygeus Iliococcygeus Piriformis
Obturator internus
The coccygeus, pubococcygeus and iliococcygeus form part of the pelvic diaphragm and are not related to it. The piriformis exits the pelvis via the greater sciatic foramen and is not associated with the canal in the ischiorectal fossa.
Where are the greatest proportion of musculi pectinati found?
Right ventricle Left ventricle Right atrium Pulmonary valve Aortic valve
Right atrium
The musculi pectinati are found in the atria, hence the reason that the atrial walls in the right atrium are irregular anteriorly.
The musculi pectinati of the atria are internal muscular ridges on the anterolateral surface of the chambers and they are only present in the area derived from the embryological true atrium.
What is the lymphatic drainage of the upper ureter?
Common iliac nodes Para aortic nodes External iliac nodes Internal iliac nodes Meso colic nodes
Para aortic nodes
The upper ureter drains to the para-aortic nodes, the lower ureter drains to the common iliac nodes
Which of the nerves listed below provides sensory innervation to the skin overlying the lateral aspect of the nose?
Infratrochlear nerve Zygomatic nerve Nasopalatine nerve Lateral nasal branches of the ethmoidal nerve Frontal nerve
Lateral nasal branches of the ethmoidal nerve
The lateral aspect of the external nose is innervated by lateral nasal branches of the anterior ethmoidal nerve. The ethmoidal nerve is a branch of the nasociliary nerve which is one of the divisions of the trigeminal.
Which of the following structures separates the subclavian artery and vein?
Digastric muscle Prevertebral fascia Anterior scalene muscle Middle scalene muscle Omohyoid
Anterior scalene muscle
The anterior scalene muscle is an important anatomical landmark and separates the subclavian vein (anterior) from the subclavian artery (posterior).
A 33 year old man is stabbed in the right chest and undergoes a thoracotomy. The right lung is mobilised and the pleural reflection at the lung hilum is opened. Which of the structures listed below does not lie within this region?
Pulmonary artery Azygos vein Pulmonary vein Bronchus None of the above
Azygos vein
The pleural reflections encase the hilum of the lung and continue inferiorly as the pulmonary ligament. It encases the pulmonary vessels and bronchus. The azygos vein is not contained within it.
A 56 year old man requires long term parenteral nutrition and the decision is made to insert a PICC line for long term venous access. This is inserted into the basilic vein at the region of the elbow. As the catheter is advanced, into which venous structure is the tip of the catheter most likely to pass from the basilic vein?
Subclavian vein Axillary vein Posterior circumflex humeral vein Cephalic vein Superior vena cava
Axillary vein
The basilic vein drains into the axillary vein and although PICC lines may end up in a variety of fascinating locations the axillary vein is usually the commonest site following from the basilic. The posterior circumflex humeral vein is encountered prior to the axillary vein. However, a PICC line is unlikely to enter this structure because of its angle of entry into the basilic vein.
An individual is noted to have a left sided superior vena cava. By which pathway is blood from this system most likely to enter the heart?
Via the coronary sinus Via the azygos venous system and into the superior vena cava Via anomalies in the pumonary vascular bed Via the left atrium and persistent foramen ovale Directly into the roof of the right atrium
Via the coronary sinus
Persistent left superior vena cava is the most common anomaly of the thoracic venous system. It is prevalent in 0.3% of the population and is a benign entity of failed involution during embryogenesis.
An 8 year old boy falls onto an outstretched hand and sustains a supracondylar fracture. In addition to a weak radial pulse the child is noted to have loss of pronation of the affected hand. Which nerve is compromised?
Median Radial Ulnar Musculocutaneous Axillary
Median
This is a common injury in children. In this case the angulation and displacement have resulted in median nerve injury.
A 40 year old lady trips and falls through a glass door and sustains a severe laceration to her left arm. Amongst her injuries it is noticed that she has lost the ability to adduct the fingers of her left hand. Injury to which of the following nerves is most likely to account for her examination findings?
Ulnar Median Radial Musculocutaneous Axillary
Ulnar
The interossei are supplied by the ulnar nerve.
A 53 year old man is undergoing a radical gastrectomy for carcinoma of the stomach. Which of the following structures will need to be divided to gain access to the coeliac axis?
Lesser omentum Greater omentum Falciform ligament Median arcuate ligament Gastrosplenic ligament
Lesser omentum
The lesser omentum will need to be divided. During a radical gastrectomy this forms one of the nodal stations that will need to be taken.
A 76 year old man complains of symptoms of claudication. The decision is made to measure his ankle brachial pressure index. The signal from the dorsalis pedis artery is auscultated with a hand held doppler device. This vessel is the continuation of which of the following?
Posterior tibial artery Anterior tibial artery Peroneal artery Popliteal artery None of the above
Anterior tibial artery
The dorsalis pedis is a continuation of the anterior tibial artery.
A 67 year old man is due to undergo a revisional total hip replacement using a posterior approach. After dividing gluteus maximus in the line of its fibres there is brisk arterial bleeding. Which of the following vessels is likely to be responsible?
Profunda femoris artery External iliac artery Internal iliac artery Obturator artery Inferior gluteal artery
Inferior gluteal artery
The inferior gluteal artery runs on the deep surface of the gluteus maximus muscle. It is a branch of the internal iliac artery. It is commonly divided during the posterior approach to the hip joint.
A 17 year old lady presents with right iliac fossa pain and diagnosed as having acute appendicitis. You take her to theatre to perform a laparoscopic appendicectomy. During the procedure the scrub nurse distracts you and you inadvertently avulse the appendicular artery. The ensuing haemorrhage is likely to be supplied directly from which vessel?
Inferior mesenteric artery Superior mesenteric artery Ileo-colic artery Internal iliac artery None of the above
Ileo-colic artery
The appendicular artery is a branch of the ileocolic artery.
Which of the vessels listed below is the most inferiorly sited single aortic branch?
Common iliac artery Inferior mesenteric artery Superior mesenteric artery Gonadal artery Median sacral artery
Median sacral artery
The median sacral artery leaves the aorta a little above its bifurcation. It descends in the midline anterior to L4 and L5.
A 63 year old man who smokes heavily presents with dyspepsia. He is tested and found to be positive for helicobacter pylori infection. One evening he has an episode of haematemesis and collapses. What is the most likely vessel to be responsible?
Portal vein Short gastric arteries Superior mesenteric artery Gastroduodenal artery None of the above
Gastroduodenal artery
He is most likely to have a posteriorly sited duodenal ulcer. These can invade the gastroduodenal artery and present with major bleeding. Although gastric ulcers may invade vessels they do not tend to produce major bleeding of this nature.
Which of the following nerves is responsible for the cremasteric reflex?
Lateral femoral cutaneous nerve Femoral nerve Obturator nerve Genitofemoral nerve None of the above
Genitofemoral nerve
The motor and sensory fibres of the genitofemoral nerve are tested in the cremasteric reflex. A small contribution is also played by the ilioinguinal nerve and thus the reflex may be lost following an inguinal hernia repair.
Which of the structures listed below are not located within the mediastinum?
Thymus Heart Great vessels Arch of azygos vein Vertebral bodies
Vertebral bodies
The vertebral bodies lie outside of the mediastinum, as do the lungs.
A 22 year old man is stabbed in the chest at the level of the junction between the sternum and manubrium. Which structure is at greatest risk?
Left atrium Oesophagus Thyroid gland Inferior vena cava Aortic arch
Aortic arch
At the level of the Angle of Louis (Manubriosternal angle), is the surface marking for the aortic arch. The oesophagus is posteriorly located and at less risk.
