EMRCS ANATOMY 9 Flashcards
A 78 year old man is undergoing a femoro-popliteal bypass graft. The operation is not progressing well and the surgeon is complaining of poor access. Retraction of which of the following structures will improve access to the femoral artery in the groin?
Quadriceps Adductor longus Adductor magnus Pectineus Sartorius
Sartorius
At the lower border of the femoral triangle the femoral artery passes under the sartorius muscle. This can be retracted to improve access.
A builder falls off a ladder whilst laying roof tiles. He sustains a burst fracture of L2. The MRI scan shows complete nerve transection at this level, as a result of the injury. Which clinical sign will not be present initially?
Flaccid paralysis of the legs Extensor plantar response Sensory loss in the legs Incontinence Areflexia
Extensor plantar response
The main purpose of this question is to differentiate the features of an UMN lesion and a LMN lesion. The features of a LMN lesion include: Flaccid paralysis of muscles supplied Atrophy of muscles supplied. Loss of reflexes of muscles supplied. Muscles fasciculation
A 56 year old machinist has his arm entrapped in a steel grinder and is brought to the emergency department. On examination, he is unable to extend his metacarpophalangeal joints and abduct his shoulder. He has weakness of his elbow and wrist. What has been injured?
Ulnar nerve Axillary nerve Medial cord of brachial plexus Lateral cord of brachial plexus Posterior cord of brachial plexus
Posterior cord of brachial plexus
This is a description of a posterior cord lesion. Remember that the posterior cord gives rise to the axillary and radial nerve.
A 66 year old man with peripheral vascular disease is undergoing a below knee amputation. In which of the lower leg compartments does peroneus brevis lie?
Lateral compartment Anterior compartment Superficial posterior compartment Deep posterior compartment None of the above
Lateral compartment
The interosseous membrane separates the anterior and posterior compartments. The deep and superficial compartments are separated by the deep transverse fascia. The peroneus brevis is part of the lateral compartment.
A 70 year old man is due to undergo an arterial bypass procedure for claudication and foot ulceration. The anterior tibial artery will form the site of the distal arterial anastomosis. Which of the following structures is not closely related to it distally?
Interosseous membrane Deep peroneal nerve Tibialis posterior Extensor hallucis longus Dorsalis pedis artery
Tibialis posterior
As an artery of the anterior compartment, the anterior tibial artery is closely related to tibialis anterior. The tibialis posterior is related to it at its origin.
Which of the muscles below does not cause lateral rotation of the hip?
Obturator internus Quadratus femoris Gemellus inferior Piriformis Pectineus
Pectineus
Pectineus adducts and medially rotates the femur.
Which of the following is not a content of the posterior triangle of the neck?
Spinal accessory nerve Phrenic nerve External jugular vein Occipital lymph nodes Internal jugular vein
Internal jugular vein
The IJV does not lie in the posterior triangle. However, the terminal branches of the external jugular vein do.
Which nerve is at risk during submandibular gland excision?
Maxillary nerve Buccal nerve Zygomatic nerve Marginal mandibular nerve Cervical nerve
Marginal mandibular nerve
The marginal mandibular nerve lies deep to platysma. It supplies the depressor anguli oris and the depressor labii inferioris. If injured it may lead to facial asymmetry and dribbling.
In a patient with a carcinoma of the distal sigmoid colon, what is the most likely source of its blood supply?
Ileocolic artery External iliac artery Internal iliac artery Superior mesenteric artery Inferior mesenteric artery
Inferior mesenteric artery
During a high anterior resection of such tumours, the inferior mesenteric artery is ligated. Note that the branches (mainly middle rectal branch) of the internal iliac artery are important in maintaining vascularity of the rectal stump and hence the integrity of the anastomoses.
Which of these openings transmits the facial nerve into the temporal bone?
Internal acoustic meatus Foramen lacerum Foramen spinosum Stylomastoid foramen Jugular foramen
Internal acoustic meatus
It enters the temporal bone through the internal acoustic meatus and exits through the stylomastoid foramen.
A motor cyclist is involved in a road traffic accident causing severe right shoulder injuries. He is found to have an adducted, medially rotated shoulder. The elbow is fully extended and the forearm pronated. Which is the most likely diagnosis?
C8, T1 root lesion C5, C6 root lesion Radial nerve lesion Ulnar nerve lesion Axillary nerve lesion
C5, C6 root lesion
The motorcyclist has had an Erb’s palsy (C5, C6 root lesion). This is commonly known to be associated with birth injury when a baby has a shoulder dystocia.
A patient is due to undergo a right hemicolectomy for a carcinoma of the caecum. Which of the following vessels will require high ligation to provide optimal oncological control?
Middle colic artery Inferior mesenteric artery Superior mesenteric artery Ileo-colic artery None of the above
Ileo-colic artery
The ileo - colic artery supplies the caecum and would require high ligation during a right hemicolectomy. The middle colic artery should generally be preserved when resecting a caecal lesion.
This question is essentially asking you to name the vessel supplying the caecum. The SMA does not directly supply the caecum, it is the ileocolic artery which does this.
A 40-year-old man presents with pain in his lower back and ‘sciatica’ for the past three days. He describes bending down to pick up a washing machine when he felt ‘something go’. He now has severe pain radiating from his back down the right leg. On examination he describes paraesthesia over the anterior aspect of the right knee and the medial aspect of his calf. Power is intact and the right knee reflex is diminished. The femoral stretch test is positive on the right side. Which nerve or nerve root is most likely to be affected?
Common peroneal nerve Lateral cutaneous nerve of the thigh L5 L3 L1
L3
A 72 year old man is undergoing a repair of an abdominal aortic aneurysm. The aorta is cross clamped both proximally and distally. The proximal clamp is applied immediately inferior to the renal arteries. Both common iliac arteries are clamped distally. A longitudinal aortotomy is performed. After evacuating the contents of the aneurysm sac a significant amount of ongoing bleeding is encountered. This is most likely to originate from:
The coeliac axis Testicular artery Splenic artery Superior mesenteric artery Lumbar arteries
Lumbar arteries
The lumbar arteries are posteriorly sited and are a common cause of back bleeding during aortic surgery. The other vessels cited all exit the aorta in the regions that have been cross clamped.
Which of the following statements relating to sartorius is untrue?
It is supplied by the femoral nerve It forms the lateral boundary of the femoral triangle The middle third forms the roof of the adductor canal It is a flexor of the hip and knee It inserts into the medial femoral condyle
It inserts into the medial femoral condyle
It inserts into the medial aspect of the upper part of the tibia.
A 35 year old man is admitted to hospital with vomiting, nausea and severe headaches. An MRI scan reveals a tumour of the cerebellopontine angle. Which one of the following pairs of cranial nerves is most likely to be compressed by this tumour?
Accessory and vagus Facial and vagus Facial and vestibulocochlear Glossopharyngeal and vestibulocochlear Vagus and vestibulocochlear
Facial and vestibulocochlear
The commonest lesion to affect this site is an acoustic neuroma. Therefore the vestibulocochlear nerve is commonly compromised. Larger lesions may also affect the facial nerve which lies closest to this site.
A 63 year old man undergoes a radical cystectomy for carcinoma of the bladder. During the procedure there is considerable venous bleeding. What is the primary site of venous drainage of the urinary bladder?
Vesicoprostatic venous plexus Internal iliac vein External iliac vein Gonadal vein Common iliac vein
Vesicoprostatic venous plexus
The urinary bladder has a rich venous plexus surrounding it, this drains subsequently into the internal iliac vein. The vesicoprostatic plexus may be a site of considerable venous bleeding during cystectomy.
A man sustains a laceration between the base of the little finger and wrist. Several weeks after the injury there is loss of thumb adduction power. Which nerve is most likely to have been injured?
Superficial ulnar nerve Deep ulnar nerve Median nerve Radial nerve Recurrent branch of median nerve
Deep ulnar nerve
A 60 year old female is undergoing a Whipples procedure for adenocarcinoma of the pancreas. As the surgeons begin to mobilise the pancreatic head they identify a large vessel passing inferiorly over the anterior aspect of the uncinate process. What is it likely to be?
Superior mesenteric artery Coeliac axis Inferior mesenteric artery Aorta Left gastric artery
Superior mesenteric artery
The superior mesenteric artery arises from the aorta and passes anterior to the lower part of the pancreas. Invasion of this structure is a relative contra indication to resectional surgery.
A 23 year old man has a cannula inserted into his cephalic vein. Through which structure does the cephalic vein pass?
Interosseous membrane Triceps Pectoralis major Clavipectoral fascia Tendon of biceps
Clavipectoral fascia
The cephalic vein penetrates the clavipectoral fascia (but not the pectoralis major) prior to terminating in the axillary vein.
