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.
An 18 year old man is undergoing an orchidectomy via a scrotal approach. The surgeons mobilise the spermatic cord. From which of the following is the outermost layer of this structure derived?
Internal oblique aponeurosis External oblique aponeurosis Transversalis fascia Rectus sheath Campers fascia
External oblique aponeurosis
The outermost covering of the spermatic cord is derived from the external oblique aponeurosis.This layer is added as the cord passes through the superficial inguinal ring.
Which of the following is not a carpal bone?
Trapezium Triquetrum Trapezoid Trapezius Lunate
Trapezius
Trapezius is a muscle of the back.
A 53 year old male presents with a carcinoma of the transverse colon. Which of the following structures should be ligated close to their origin to maximise clearance of the tumour?
Superior mesenteric artery Inferior mesenteric artery Middle colic artery Ileo-colic artery Superior rectal artery
Middle colic artery
The middle colic artery supplies the transverse colon and requires high ligation during cancer resections. It is a branch of the superior mesenteric artery.
Which of the following structures are not closely related to the adductor longus muscle?
Long saphenous vein Tendon of iliacus The profunda branch of the femoral artery Pectineus muscle Femoral nerve
Tendon of iliacus
Adductor longus forms the medial border of the femoral triangle. It is closely related to the long saphenous vein which overlies it and the profunda branch of the femoral artery. The femoral nerve is related to it inferiorly. However, the tendon of iliacus inserts proximally and is not in contact with adductor longus.
Which of the following structures does not lie posterior to the right kidney?
Psoas major 12th rib Quadratus lumborum Iliolumbar ligament 10th rib
10th rib
The 8th and10th ribs lie more superiorly. The 12th rib is a closer relation posteriorly.
A 56 year old man is undergoing a radical nephrectomy via a posterior approach. Which of the following structures is most likely to be encountered during the operative approach?
8th rib 10th rib 6th rib 12th rib 9th rib
12th rib
The 11th and 12th ribs lie posterior to the kidneys and may be encountered during a posterior approach. A pneumothorax is a recognised complication of this type of surgery.
A 73 year old lady presents with a femoral hernia. Which of the following structures forms the lateral wall of the femoral canal?
Pubic tubercle Femoral vein Femoral artery Conjoint tendon Femoral nerve
Femoral vein
The canal exists to allow for the physiological expansion of the femoral vein, which lies lateral to it.
Which of the nerves listed below is responsible for the innervation of gluteus medius?
Inferior gluteal nerve Sciatic nerve Superior gluteal nerve Perineal nerve Inferior rectal nerve
Superior gluteal nerve
Which of these muscles is not a component of the rotator cuff?
Subscapularis Teres minor Supraspinatus Infraspinatus Deltoid
Deltoid
Deltoid may abduct the shoulder and is not a rotator cuff muscle.
Which of the following muscles is not within the posterior compartment of the lower leg?
Peroneus brevis Flexor digitorum longus Soleus Popliteus Flexor hallucis longus
Peroneus brevis
Peroneus brevis lies in the lateral compartment.
How many unpaired branches leave the abdominal aorta to supply the abdominal viscera?
One Two Three Four Five
Three
There are three unpaired branches to the abdominal viscera. These include the coeliac axis, the SMA and IMA.
A 34 year old man with a submandibular gland stone is undergoing excision of the submandibular gland. The incision is sited transversely approximately 4cm below the mandible. After incising the skin, platysma and deep fascia which of the following structures is most likely to be encountered.
Facial artery Facial vein Lingual nerve Hypoglossal nerve Glossopharyngeal nerve
Facial vein
When approaching the submandibular gland the facial vein and submandibular lymph nodes are the most superficially encountered structures.
You are working as an anatomy demonstrator and the medical students decide to test your knowledge on the Circle of Willis. Which of the following comments is false?
The anterior communicating artery links the right and left sides Asymmetry of the circle of willis is a risk factor for the development of intracranial aneurysms Majority of blood passing through the vessels mix together Includes the anterior communicating artery The circle surrounds the stalk of the pituitary gland
Majority of blood passing through the vessels mix together
There is minimum mixing of blood passing through the vessels.
A 45 year old man presents with bilateral inguinal hernias. The surgical team decide to repair these laparoscopically through an extraperitoneal approach. Through an infraumbilical incision the surgeons displace the inferior aspect of the rectus abdominis muscle anteriorly and place a prosthetic mesh into the area to repair the hernias. Which structure will lie posterior to the mesh?
Peritoneum Internal oblique aponeurosis External oblique aponeurosis Posterior aspect of the rectus sheath Bucks fascia
Peritoneum
During a TEP repair of inguinal hernia the only structure to lie posterior to the mesh is peritoneum.
A 20 year old man undergoes an open appendicectomy performed via a lanz incision. This surgeon places the incision on a level of the anterior superior iliac spine in an attempt to improve cosmesis. During the procedure the appendix is found to be retrocaecal and the incision is extended laterally. Which of the following nerves is at greatest risk of injury?
Genitofemoral Ilioinguinal Obturator Lateral femoral cutaneous Femoral
Ilioinguinal
The femoral nerve is transected by a rather careless surgeon during a botched femoro-popliteal bypass operation. Which of the following actions will be impaired?
Extension of the great toe Adduction of the thigh Flexion of the knee joint Extension of the knee joint Eversion of the foot
Extension of the knee joint
The femoral nerve supplies the quadriceps muscle which is responsible for extension at the knee joint
Which of the following is not a direct branch of the facial nerve?
Greater petrosal nerve Nerve to stapedius Auriculotemporal Chorda tympani Buccal
Auriculotemporal
The auriculotemporal nerve is a direct branch of the mandibular nerve.
A 32 year old man is stabbed in the neck and the inferior trunk of his brachial plexus is injured. Which of the modalities listed below is least likely to be affected?
Initiating abduction of the shoulder Abduction of the fingers Flexion of the little finger Sensation on the palmar aspect of the little finger Gripping a screwdriver
Initiating abduction of the shoulder
The inferior trunk of the brachial plexus is rarely injured. Nerve roots C8 and T1 are the main contributors to this trunk. Therefore an injury to this site will most consistently affect the ulnar nerve. The inferior trunk also contributes to the median nerve by way of the medial cord and therefore some impairment of grip is almost inevitable.
A 42 year old teacher is admitted with a fall. An x-ray confirms a fracture of the surgical neck of the humerus. Which nerve is at risk?
Median Radial Axillary Muscuculocutaneous Subscapular
Axillary
The Axillary nerve winds around the bone at the neck of the humerus. The axillary nerve is also at risk during shoulder dislocation.
During embryological development, which of the following represent the correct origin of the pancreas?
Ventral and dorsal endodermal outgrowths of the duodenum Ventral and dorsal outgrowths of mesenchymal tissue from the posterior abdominal wall Ventral and dorsal outgrowths of the vitellointestinal duct Ventral and dorsal biliary tract diverticulae Buds from the inferior aspect of the caudate lobe
Ventral and dorsal endodermal outgrowths of the duodenum
The pancreas develops from a ventral and dorsal endodermal outgrowth of the duodenum.
Which of the following is not a content of the anterior triangle of the neck?
Ansa cervicalis Vagus nerve Anterior jugular vein Transverse cervical nerve Hypoglossal nerve
Transverse cervical nerve
The transverse cervical nerve lies within the posterior triangle. The anterior jugular vein is formed in the submental region and descends in the superficial fascia near the median plane. It passes inferior to enter the suprasternal space, it is linked to the contralateral anterior jugular vein by the jugular venous arch.
A 23 year old man presents with delayed diagnosis of appendicitis. The appendix is retrocaecal and has perforated causing a psoas abscess. Into which structure does the psoas major muscle insert?
Greater trochanter of the femur Linea aspera of the femur Lesser trochanter of the femur Iliac crest None of the above
Lesser trochanter of the femur
The psoas major inserts into the lesser trochanter.
A 63 year old man is due to undergo a splenectomy. Which splenic structure lies most posteriorly?
Gastrosplenic ligament Splenic vein Splenic artery Splenic notch Lienorenal ligament
Lienorenal ligament
The lienorenal ligament lies most posteriorly. The antero-lateral connection is via the phrenicocolic ligament. Anteriorly the gastro splenic ligament. These structures condense around the vessels at the splenic hilum.
Which of these statements relating to the external carotid is false?
It ends by bifurcating into the superficial temporal and ascending pharyngeal artery Its first branch is the superior thyroid artery The superior thyroid, lingual and facial arteries all arise from its anterior surface The ascending pharyngeal artery is a medial branch Initially it lies anteromedial to the internal carotid
It ends by bifurcating into the superficial temporal and ascending pharyngeal artery
It terminates by dividing into the superficial temporal and maxillary branches.
The recurrent laryngeal is connected to which of the following nerves?
Trigeminal Accessory Hypoglossal Vagus Glossopharyngeal
Vagus
Which of the following statements about the spleen is false?
The hilum contains the splenic vessels. The spleen is derived from endodermal tissue. The white pulp has immune function. The colon lies inferiorly. Weighs 150g.
The spleen is derived from endodermal tissue.
Most of the gut is derived endodermally except for the spleen which is from mesenchymal tissue.
As it exits the axilla the radial nerve lies under which of the following muscles?
Supraspinatus Infraspinatus Teres major Deltoid Pectoralis major
Teres major
The radial nerve passes through the triangular interval to leave the axilla. The superior border of this is bounded by the teres major muscle to which the radial nerve is closely related.
Into which of the following veins does the middle thyroid vein drain?
Vertebral External jugular Internal jugular Subclavian Anterior jugular
Internal jugular
It drains to the internal jugular vein. Which is one of the reasons why it bleeds so copiously if a ligature slips.
Which of the following structures is not at the level of the transpyloric plane?
Hilum left kidney Superior mesenteric artery Fundus of the gallbladder Cardioesophageal junction Root of transverse mesocolon
Cardioesophageal junction
Cardiooesophageal junction level = T11
A 62 year old man presents with arm weakness. On examination, he has a weakness of elbow extension and loss of sensation on the dorsal aspect of the first digit. What is the site of the most likely underlying defect?
Axillary nerve Median nerve Ulnar nerve Radial nerve Musculocutaneous nerve
Radial nerve
The long head of the triceps muscle may be innervated by the axillary nerve and therefore complete loss of triceps muscles function may not be present even with proximally sited nerve lesions.
From which of the following structures does the long head of the triceps muscle arise?
Coracoid process Acromion Infraglenoid tubercle Coraco-acromial ligament Coraco-humeral ligament
Infraglenoid tubercle
The long head arises from the infraglenoid tubercle.
