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1
Q

What is the main structure that determines the descent path of the testicle?

A

Gubernaculum. Connects the testis to the inferior aspect of the scrotum. Embrionically, it is long and connected to the posterior abdominal wall. During fetal growth the body grows relative to gubernaculum, which results in the descent of the testis.

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2
Q

Where are the testis located in the 3rd month and 7th months of gestation?

A

3rd - iliac fossae, 7th - deep inguinal ring.

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3
Q

Which harmstring muscle is located most laterally?

A

Biceps femoris. Long head.

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4
Q

Which arteries may bleed after cross clamping abdominal aorta?

A

Lumbar arteries. They are posteriorly cited.

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5
Q

What is a Trendelenburg gait?

A

Damage to the superior gluteal nerve (hip replacement, nephrectomy, injection) → weakness of abductor muscles (glueteus medius) → drop of pelvis to contralateral side + unability to abduct the thigh. Compenstated Tr. sign - the trunk lurches to the weakened side.

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6
Q

Which is the correct embryological origin of the stapes?

A

2nd pharyngeal arch.

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7
Q

What nerve may Gantzer muscle affects?

A

Median and anterior interosseous nerves. A loss of pincer grip is related to the anterior interosseous nerve.

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8
Q

What are the motor functions of the brachial plexus myotomes?

A

C5 - abduction

C6 - flexion of the elbow

C7 - extension

C8 - finger flexion

T1 - finger abduction

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9
Q

What are the sensory functions of the brachial plexus?

A

C5, C6 (upper roots) - lateral side.

C7, C8 (middle root) - hand

T1 (lower root) - medial part of arm and forearm

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10
Q

What are the borders of Calot’s triangle?

A

Upper - liver; lateral - cystic duct; medial - common hepatic duct. Inside is the cystic artery. Original borders of Calot - with the cystic artery above.

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11
Q

What does the Calot’s triangle contain?

A

Cystic artery; below her - the Mascagni’s lymph node (or Lund’s node).

Sometimes - the accessory right hepatic artery.

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12
Q

What does Cholecystokinin?

A

Causes contraction of the gallbladder

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13
Q

What contains cavernous sinus?

A

OTOM CAT

Oculomotor (III), Trochlear (IV), Ophthalmic (5V1), Maxillary (5V2) nerves

Carotid internal artery, Abducens nerve (VI), Trochlear,

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14
Q

What is a cavernous sinus syndrome?

A

Most commonly caused by tumours.

Pain, proptosis, ophthalmoplegia, trigeminal nerve lesion, Horner’s syndrome

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15
Q

Which nerve can be injured during parotidectomy?

A

Greater auricular. Facial nerve injury is less common.

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16
Q

What causes a winged scapula?

A

Damage to the long thoracic nerve (lymphadenectomy in breast cancer) (from C5, C6, C7; innervates serratus anterior muscle. Its origin is in the medial border of the scapula).

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17
Q

What damages in a crutch palsy?

A

Radial nerve. As it is derived from the posterior cord. Wrist drop.

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18
Q

What is the most common position of the appendix?

A

Retrocaecal - 64%, pelvic - 32%.

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19
Q

What is located at the transpyloric plane?

A

Addison plane. Halfway between the suprasternal notch and the upper border of symphisis, at the level of the L1. Spleen - lower pole. Itself is above. The fundus of the gallbladder is the most superfifical; at right of the rectus sheath.

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20
Q

Injury to which nerve causes a foot drop? Tight casting.

A

Common peroneal nerve. Wraps around the fibular head.

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21
Q

What are the borders of epiploic foramen?

A

Anteriorly - common bile duct, portal vein, hepatic artery (hepatoduodenal ligament)

Posteriorly - inferior vena cava

Inferiorly - 1st part of the duodenum

Superiorly - caudate process of the liver.

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22
Q

Where does the psoas muscle connect?

A

Lesser trochanter.

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23
Q

How to distinguish upper vs lower motor neuron lesion of Facial nerve?

A

Upper motor neurons receive innervation bilaterally; lower motor neuron only from contralateral side. The border line is between the eyes. So eyebrows are indicators of upper motor lesion.

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24
Q

What is Sibson’s fascia?

A

A thickening of endothoracic fascia in the apex of the lungs. It prevents the neck being inflated on inhale and runs from C1 to C7.

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25
Q

What is the lymphatic drainage of ovaries?

A

Paraaortic nodes

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26
Q

What is the lymphatic drainage of the uterus?

A

Fundus - along with ovarian vessels to paraaortic nodes + along the round ligament to the inguinal nodes.

Body - broad ligament to iliac lymph nodes

Cervix - laterally along

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27
Q

Which parts form the celiac plexus?

A

Celiac → aorticorenal → superior mesenteric

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28
Q

Where is coeliac plexus located?

A

Anterior to aorta

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29
Q

What proportion of saliva is produced by submandibular gland?

A

70%. 25% - parotid. 5% - sublingual.

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30
Q

What is an anterior border of posterior mediastinum?

A

Prevertebral fascia. It means that vertebras are not in the mediastinum!

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31
Q

How ulnar artery corresponds to the ulnar nerve in the level of the wrist joint?

A

lateral

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32
Q

What structures pass through the great sciatic foramen?

A

Greater sciatic foramen itself is divided in two parts by piriformis muscle (from sacrum to the great trochanter).

Suprapiriform: Sup. gluteal artery, Sup. gluteal nerve

Infrapiriform: POPS IQ = Pudendal nerve to Obturator internus, Posterior femoral cutaneous nerve, Sciatic nerve, Inferior gluteal artery + nerve, nerve to Quadratus femoris.

Pudendal nerve exits greater foramen then goes through the lesser one.

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33
Q

At which level does the aorta traverse the diaphragm?

A

Th12

I ate 10 Eggs At 12’ I (IVC) ate (T8) 10 (T10) eggs (eosophagus) At (aorta) 12 (T12)

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34
Q

What does separate spinal cord from the intervertebral disk?

A

Post. Longitudinal ligament

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35
Q

What is the lymph drainage of the ureter?

A

Upper - paraaortic nodes; lower - common iliac.

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36
Q

What are the hormones of posterior pituitary gland?

A

Oxytocin + ADH

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37
Q

What are the hormones of the anterior pituitary gland?

A

Growth hormone; TSH; ACTH; LH + FSH; Prolactine; Melanocyte releasing hormone

FLAT PeG

FSH, LH, ACTH, TSH, Prolactine, Growth

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38
Q

What separates pituitary gland from optic chiasm?

A

Dural fold!

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39
Q

Which vessels can be damaged during a removal of the submandibular gland?

A

Facial artery + vein. Later, when the Whartons duct is mobilised - lingular artery

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40
Q

What are the birth injuries to the brachial plexus?

A

Erbb’s uPPer roots = Waiter’s tip C5 C6

kLumpke’s Lower roots = Klawing C8 T1

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41
Q

Which muscles are not innervated by median nerve at the forearm?

A

Flexor carpi ulnaris; median half of flexor digitorum profundus.

Ape hand - lesion to the median nerve. 4 and 5 fingers will bend!

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42
Q

Which branch of median nerve goes above the carpal tunnel?

A

Palmar branch.

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43
Q

What is the cause of claw hand?

A

Lesion to the ulnar nerve. It innervates ulnar half of flexor digitorum profundus, flexor carpi ulnaris. More proximal lesion (at elbow), lesser is contracture due to the activity of extensor digitorum

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44
Q

Motor branch of the median nerve?

A

Anterior interosseous nerve. May be impared in humerus fracture at elbow. Abnormal OK sign due to the impairment of radial hal of flexor digitorum profundus. Plus Benedictine sign!

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45
Q

How to remember radial nerve supply?

A

BEAST - brachialis, Extensors, Anconeus, Supinators, Triceps

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46
Q

What can be injured during saphenous grafting?

A

Deep external pudendal vessels

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47
Q

Where does axillary artery and radial nerve passes on the arm?

A

Quadratum space; radial - triceps hiatus

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48
Q

Which muscles ulnar nerve supplies at the hand?

A

All intrinsic muscles except LOAF:

Lateral two lumbricals

Opponens pollicis

Abductor pollicis brevis

Flexor pollicis brevis

They are innervated by median nerve

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49
Q

How to distinguish abductor interossei of the fingers from adductors?

A

PAD DAB

Palmar - adductors; Dorsal - abductors

50
Q

What is special about thumb innervation?

A

All goes from median nerve EXCEPT adductor pollicis - goes from ulnar nerve.

If ulnar nerve is damaged you can not do ADDUCTION of the thumb

51
Q

Features of carpal tunnel syndrome?

A

Inability to oppose the thumb.

Atrophy to thenar eminence, thumb is ADDUCTED (adductor is innervated by ulnaris) and extended - SIMIAN hand

52
Q

How anatomical structures are located in the cubital fossa?

A

TAN - tendon Artery Nerve

53
Q

What are relations of median nerve to brachial artery?

A

LAM - it starts lateral on the arm then traverse anteriorly and after is situated medially

54
Q

What is a Froment’s sign?

A

Laceration to ulnar nerve - impaired adduction of thenar. Compensates by flexion by median nerve

55
Q

How can scapula be supplied if subclaavian artery is divided?

A

Anastomosis between dorsal scapulae (last branch of subclavian) and subscapular artery (its branch circumflex scapular artery)

56
Q

Borders of cubital fossa?

A

Lateral - brachioradials; medial - pronator teres; floor - brachialis.

57
Q

When the patient will be able to extend his dropped wrist but won’t be able to extend his fingers?

A

Posterior interosseous nerve injury

58
Q

Injury to median nerve?

A

Supracondylar fracture. Unable to flex the wrist. Pointing index finger. 1-2-3 do not flex.

At the level of the wrist - unable to ABDUCT the thumb (adductors are by ulnar nerve).

59
Q

Injury to ulnar nerve?

A

Ebove epicondyle - claw hand

Interossei - adduction, abduction of fingers, crossing, adduction of 5th, thumb

High lesion - less claw hand

60
Q

Innervation of the middle finger?

A

C7

61
Q

How does the lymph drain from the rectum?

A

Superior to dentate line → mesorectal nodes

Inferior to dentate line → inguinal nodes (need to be removed from the groin)

62
Q

Lymph drainage of prostate?

A

Internal iliacs!!!

63
Q

What causes a shoulder abduction?

A

Suprascapular nerve. Aided by deltoid, which is innervated by axillary nerve, after first 15 degrees.

64
Q

Which nerves goes directly from brachial plexus?

A

Long thoracic nerve

Dorsal scapular

Suprascapular

Subclavius

65
Q

Where is the spinal cord located in newborns?

A

L3. In adulthood L1-2. In fetus it takes all the vertebral canal

66
Q

How is adrenal gland supplied?

A

Superior adrenal artery - from phrenic

Middle adrenal artery - from aorta

Inferior adrenal artery - from renal artery

67
Q

Which muscle divides subclavian artery?

A

Anterior scalene

68
Q

Which dermatome is responsible for knee area?

A

L3

69
Q

Which nerve roots flexes and extend the hip?

A

Flexion - L2, L3

Extension - L4, L5

70
Q

Arterial supply of lacrimal gland?

A

Ophthalmic artery

71
Q

The most common site of congenital diaphragmatic hernia?

A

Bochdalek space

72
Q

Projection of Inferior mesenteric artery?

A

L3

73
Q

Formation of IVC?

A

L5 (union of common iliac veins)

74
Q

How does the persistent left-sided SVC drains to the heart?

A

via coronary sinus

75
Q

The most susceptible cranial nerve for raised ICP?

A

Abducens CN VI. It has a long intracranial course. It also passes over the petrous temporal bone, so can be damaged in mastoiditis.

76
Q

Which structure is not located in superficial perineal space in females?

A

Pudendal nerve. It lies in the deep perineal space

77
Q

Which of the laryngeal tumours will not typically metastasise to deep cervical nodes?

A

Glottic. The vocal cords have no lymphatic draingage

78
Q

Blood supply to rectum?

A

Superior rectal artery - inferior mesenteric artery

Middle rectal artery - internal iliac artery

Inferior rectal artery - internal pudendal artery

79
Q

Mnemonic for layers of testis?

A

Some (skin) Damned (dartos) Examiner (externa; spermatic fascia) Called (cremasteric fascia) It (internal spermatic fascia) The (tunica vaginalis) Testis.

Some Damned Examiner Called It The Testis

80
Q

Which muscles are inserted to the greater trochanter?

A

POGO

Piriformis

Obturator internus

Gemelli

Obturator externus

81
Q

From which roots phrenic nerve is dervied?

A

C3,4,5

Keeps the diaphragm alive!

82
Q

Which nerves are at risk during carotid endarterectomy?

A

Hypoglossal

Greater auricular

Superior laryngeal

83
Q

Structures of sciatic foramens?

A

Lesser:

Posterior cutaneous nerve of the thigh

Inferior gluteal artery, nerve

Nerve to quadratus femoris

Pudendal nerve

Internal pudendal artery and vein

Nerve to obturator internus

Sciatic nerve

PIN PINS

84
Q

What is the most important structure involved in supporting the uterus?

A

Central perineal tendon. Provides main support to the uterus. Damage is associated with a prolapse.

85
Q

Which muscle at the hand is innervated by median?

A

abductor policis brevis

86
Q

Which artery goes anterior to the lowest part of the pancreas? (uncinate)

A

Superior mesenteric

87
Q

Which structure lies medial to arteria dorsal pedia?

A

Tendon of extensor hallucis longus. Laterally - extensor hallucis brevis muscle

88
Q

Abdominal incision for renal transplant?

A

Rutherford Morrison

89
Q
  • Embryological aortic arches???
A
  • Embryological aortic arches???1+2 - disappears early. 1 - maxillary artery. 2 - external carotid artery.3 - internal carotid artery4 - right - right subclavia, left - arch of the aorta5 - regresses6 - pulmonary artery, ductus arteriosus
90
Q

Origins of triceps?

A

Long head - infraglenoid tubercle

Medial head - posterior surface of the humerus inferior to radial groove

Lateral head - posterior surface of the humerus superior to radial groove

91
Q

How is the inguinal ligament formed?

A

From external oblique aponeurosis

92
Q

Auscultation points?

A

Pulmonary - 2 left

Aortic - 2 right

Mitral - 5 left medial to mid clavicular line

Tricuspid - 4 left at the lower sternal border

93
Q

Innervation of external anal sphincter?

A

S2,3,4 Keeps poo of the floor

94
Q

60% of supply to the breast is derived from?

A

Internal mammary artery

95
Q

Which finger does not have interossei muscle?

A

3

96
Q

At which level superior mesenteric artery branches from aorta?

A

L1

97
Q

Which of the nerves listed below is directly responsible for the innervation of the lateral aspect of flexor digitorum profundus?
Ulnar nerve

Anterior interosseous nerve

Radial nerve

Median nerve

Posterior interosseous nerve

A

The anterior interosseous nerve is a branch of the median nerve and is responsible for innervation of the lateral aspect of the flexor digitorum profundus.

98
Q

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 (bar the anterolateral aspect of the posterior cruciate ligament) 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

A

The posterior aspect is intrasynovial and the knee itself comprises the largest synovial joint in the body. It may swell considerably following trauma such as ACL injury. Which may be extremely painful owing to rich innervation from femoral, sciatic and ( a smaller) contribution from the obturator nerve. During full extension all ligaments are taut and the knee is locked.

99
Q

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

A

Because the kidney is present, rather than absent, the adrenal will usually develop and in the normal location.

100
Q

An 18 year old man is cutting some plants when a small piece of vegetable matter enters his eye. His eye becomes watery. Which of the following is responsible for relaying parasympathetic neuronal signals to the lacrimal apparatus?

Pterygopalatine ganglion

Otic ganglion

Submandibular ganglion

Ciliary ganglion

None of the above

A

The parasympathetic fibres to the lacrimal apparatus transit via the pterygopalatine ganglion.

101
Q

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

A

Palmaris brevis - Ulnar nerve
Palmar interossei- Ulnar nerve
Adductor pollicis - Ulnar nerve
Abductor pollicis longus - Posterior interosseous nerve
Abductor pollicis brevis - Median nerve
T
he 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.

102
Q

At which of the following levels does the inferior thyroid artery enter the thyroid gland?

C6

C2

C4

C3

C5

A

It enters the gland at C6.

103
Q

What is the lymphatic drainage of the male spongy urethra?

External iliac nodes

Internal iliac nodes

Para aortic nodes

Deep inguinal nodes

Meso rectal nodes

A

The lymphatic drainage of the spongy urethra and the glans penis is to the deep inguinal nodes. The prostatic and membranous urethra drains to the internal iliac nodes.

104
Q

Which of the muscles listed below is attached to the anterior aspect of the fibrous capsule that encases the elbow joint?

Pronator teres

Biceps

Brachialis

Triceps

Extensor carpi radialis longus

A

The brachialis inserts some of its fibres into the fibrous joint of the elbow capsule and when it contracts, it helps to flex the joint.

105
Q

A 78 year old lady falls over in her nursing home and sustains a displaced intracapsular fracture of the femoral neck. A decision is made to perform a hemi arthroplasty through a lateral approach. Which of these vessels will be divided to facilitate access?

Saphenous vein

Superior gluteal artery

Superficial circumflex iliac artery

Profunda femoris artery

Transverse branch of the lateral circumflex artery

A

During the Hardinge style lateral approach the transverse branch of the lateral circumflex artery is divided to gain access. The vessels and its branches are illustrated below:

106
Q

A 10 year old child has a grommet inserted for a glue ear. What type of epithelium is present on the external aspect of the tympanic membrane?

Stratified squamous

Ciliated columnar

Non ciliated columnar

Non stratified squamous

None of the above

A

The external aspect of the tympanic membrane is lined by stratified squamous epithelium. This is significant clinically in the development of middle ear infections when this type of epithelium may migrate inside the middle ear.

107
Q

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

A

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.

108
Q

A 45 year old motor cyclist sustains a tibial fracture and is noted to have anaesthesia of the web space between his first and second toes. Which of the nerves listed below is most likely to be compromised?

Superficial peroneal nerve

Deep peroneal nerve

Sural nerve

Long saphenous nerve

Tibial nerve

A

The deep peroneal nerve lies in the anterior muscular compartment of the lower leg and can be compromised by compartment syndrome affecting this area. It provides cutaneous sensation to the first web space. The superficial peroneal nerve provides more lateral cutaneous innervation.

109
Q

A 44 year old man is undergoing a parotidectomy and the surgeon is carefully preserving the facial nerve. Unfortunately his trainee then proceeds to divide it. Which of the following will not be affected as a result?

Taste sensation from anterior two thirds of the tongue

Closing the ipsilateral eyelid

Raising the ipsilateral side of the lip

Ipsilateral corneal reflex

Buccinator muscle

A

The chorda tympani branches inside the facial canal and will therefore be unaffected by this most unfortunate event! The corneal reflex is mediated by the opthalmic branch of the trigeminal nerve sensing the stimulus on the cornea, lid or conjunctiva; the facial nerve initiates the motor response of the reflex.

110
Q

Which of the following is true in relation to the sartorius muscle?

Innervated by the deep branch of the femoral nerve

Inserts at the fibula

It is the shortest muscle in the body

Forms the Pes anserinus with Gracilis and semitendinosus muscle

Causes extension of the knee

A

It is innervated by the superficial branch of the femoral nerve. It is a component of the pes anserinus.

111
Q

Which cranial nerve provides general sensation to the anterior two thirds of the tongue?

Facial

Trigeminal

Hypoglossal

Vagus

Glossopharyngeal

A

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).

112
Q

A 24 year old lady is stabbed in the buttock. Following the injury the wound is sutured in the emergency department. Eight weeks later she attends the clinic, as she walks into the clinic room she has a waddling gait and difficulty with thigh abduction. On examination she has buttock muscle wasting. Which nerve has been injured?

Superior gluteal nerve

Obturator nerve

Sciatic nerve

Femoral nerve

Inferior gluteal nerve

A

Damage to the superior gluteal nerve will result in a Trendelenburg gait.

113
Q

Which of the following bones is related to the cuboid’s distal articular surface?

All metatarsals

5th metatarsal

Calcaneum

Medial cuneiform

3rd metatarsal

A

The cuboid is located at the lateral aspect of the foot between the calcaneus posteriorly and the 4th and 5th metatarsals distally.

114
Q

A 24 year old man falls and sustains a fracture through his scaphoid bone. From which of the following areas does the scaphoid derive the majority of its blood supply?

From its proximal medial border

From its proximal lateral border

From its proximal posterior surface

Superficial palmar arch vessels

Dorsal carpal branch vessels

A

The dorsal carpal branch vessels supply 80% of the scaphoid via retrograde flow. There is a minor supply from the superficial palmar arch vessels that supplies the distal 20% of the scaphoid.

115
Q

A 53 year old lady is recovering following a difficult mastectomy and axillary nodal clearance for carcinoma of the breast. She complains of shoulder pain and on examination has obvious winging of the scapula. Loss of innervation to which of the following is the most likely underlying cause?

Latissimus dorsi

Serratus anterior

Pectoralis minor

Pectoralis major

Rhomboids

A

Winging of the scapula is most commonly the result of long thoracic nerve injury or dysfunction. Iatrogenic damage during the course of the difficult axillary dissection is the most likely cause in this scenario. Damage to the rhomboids may produce winging of the scapula but would be rare in the scenario given.

116
Q

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

A

The left main bronchus lies at T6. Topographical anatomy of the thorax is important as it helps surgeons to predict the likely structures to be injured in trauma scenarios (so popular with examiners)

117
Q

Which of the following nerves conveys sensory information from the laryngeal mucosa?

Glossopharyngeal

Laryngeal branches of the vagus

Ansa cervicalis

Laryngeal branches of the trigeminal

None of the above

A

The laryngeal branches of the vagus supply sensory information from the larynx.

118
Q

What is the nerve supply to the muscle indicated by an X on the prosection below?
CN XI

CN IX

Median pectoral nerve

Lateral pectoral nerve

Suprascapular nerve

A

Be careful not to confuse CN IX with CN XI
The muscle indicated is trapezius and it is innervated by the accessory nerve (CN XI)

119
Q

Which of the following nerves is responsible for the motor innervation of the sternocleidomastoid muscle?

Ansa cervicalis

Accessory nerve

Hypoglossal nerve

Facial nerve

Vagus nerve

A

The motor supply to the sternocleidomastoid is from the accessory nerve. The ansa cervicalis supplies sensory information from the muscle.

120
Q

A 21 year old man undergoes surgical removal of an impacted 3rd molar. Post operatively, he is noted to have anaesthesia on the anterolateral aspect of the tongue. What is the most likely explanation?

Injury to the hypoglossal nerve

Injury to the inferior alveolar nerve

Injury to the lingual nerve

Injury to the mandibular branch of the facial nerve

Injury to the glossopharyngeal nerve

A

The lingual nerve is closely related to the third molar and up to 10% of patients undergoing surgical extraction of these teeth may subsequently develop a lingual neuropraxia. The result is anaesthesia of the ipsilateral anterior aspect of the tongue. The inferior alveolar nerve innervates the teeth themselves.

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