Pre midterm

Question 1

Which of the following structures does not belong to the O Donoghue unhappy triad?
A. MCL
B. ACL
C. Medial Meniscus 
D. Tibial collateral 
E. Fibular collateral

Answer 1

E. Fibular collateral

The triad refers to a complete or partial tear of the anterior cruciate ligament, medial collateral ligament, and the medial meniscus. Medial collateral ligament is also known as tibial collateral ligament.

Question 2

Bones that contribute to Pterion.

Answer 2

Frontal, Temporal, Parietal & Sphenoid

• Pterion: Frontotemporoparietosphenoid (FTPS)
• Nasion: frontonasal
• Asterion: Parietotemporomastoid;
• Inion:highest point of external occipital protuberance;
• Glabella: cephalometric landmark superior to nasion

Question 3

Upon cranial CT scan, a biconvex hyperdense lesion is noted. What is likely the diagnosis?

Answer 3

Acute epidural hematoma

*Acute subdural hematoma-crescent shaped,hyperdense. Enhacement of the cisterns- subarachnoid hemorrhage.

Question 4

In cases of epidural hematoma, what is likely the culprit?

Answer 4

Tear of the middle meningeal vessels

• Rupture of the bridging veins: subdural hematoma.
• Rupture of an aneurysm: SAH
• Displacement of midline structures: beginning herniation

Question 5

Maneuver used to palpate the level III group of nodes in axilla.

Answer 5

Patient asked to relax the shoulder muscles, then the physician directs his finger to the outlet border of the 1st rib.

Ant Grp: Pressing forward against the posterior surface of the pectoralis major

Post grp: Pressing backward against the anterior surface of the subscapularis muscle

Lat grp: Palpating nodes located against the medial side of axillary vein

Central: Palpating nodes against the anterior and posterior walls of the axilla

(Anterior/posterior/lateral-group 1; Central-group 2; Apical-group 3)

Question 6

The aortic hiatus transmit what structures?

Answer 6

Aorta & Thoracic duct

• Caval: IVC & R phrenic nerve at level of T8;
• Esophageal: esophagus, vagus nerve at level of T10;
• Aortic: aorta, thoracic duct, azygous vein at level of T12

Question 7

Triangles of Petit.

Answer 7

Latissimus dorsi
Iliac crest
External oblique

Question 8

Auscultatory triangle.

Answer 8

Latissimus dorsi
Trapezius
External oblique

Question 9

Hesselbach triangle.

Answer 9

External oblique
Inguinal ligament
Inferior epigastric vessels

Question 10

The celiac trunk is the first anterior unpaired visceral artery of the abdominal aorta. What are its main branches?

Answer 10

Hepatic, Left gastric, and Splenic

Question 11

The widest segment of colon:

Answer 11

Cecum

*has the widest diameter and also has the highest risk for rupture if with large bowel obstruction

Question 12

58y/o male was stabbed on the RUQ, sustained multiple organ damage and was in hypovolemic shock due to massive blood loss. What segment of the large bowel is the most prone to ischemia?

Answer 12

Griffith’s point or Splenic flexure

*Griffits point or splenic flexure is one of the watershed areas of the colon. Another is the sudeck’s point/sigmoid colon. These areas are prone to the development of ischemia

Question 13

Pringle maneuver is done to control bleeding in what organ?

Answer 13

Liver

Pringle maneuver is done to determine if traumatic liver injury is from hepatic artery or portal vein.

Question 14

In pringle maneuver, what structures are clamped?

Answer 14

Portal vein, Hepatic artery

Pringle maneuver is done to determine if traumatic liver injury is from hepatic artery or portal vein, the technique includes clamping of the hepatoduodenal ligament (hepatic artery, portal vein, common bile duct).

Question 15

Different locations of humeral fracture may cause different types of nerve injury. Which is incorrectly paired?
A. Surgical neck fracture-phrenic nerve 
B. Midshaft- radial nerve
C. Supracondyoar- median nerve
D. Medial epicondylar fracture-ulnar
E. All are correctly paired

Answer 15

A. Surgical neck fracture-phrenic nerve

*Surgical neck fracture may cause axillary nerve injury.

Question 16

The following statements are true regarding flat bones?
A. Sternum and skull are examples of kat bones
B. Compact bone around a layer of spongy bone
C. Typically longer than wide
D. A and B
E. All of the above

Answer 16

flat bones:

• Sternum and skull are examples of kat bones
• Compact bone around a layer of spongy bone

Question 17

3 hours after the initial presentation, the resident physician noted the pupils to be unequal in size. What is the likely explanation for this finding?
A. Poor physical examination
B. Tonsillar herniation
C. Uncus compressing the midbrain 
D. Subfalcine herniation
E. opioid poisoning

Answer 17

C. Uncus compressing the midbrain

In uncal herniation, the temporal lobe compresses the midbrain where the CN III arises causing eye symptoms (loss of reflex and anisocoric pupils)

Question 18

True regarding direct inguinal hernia?
A. Acquired type
B. Children and young adults
C. Enters the scrotum
D. Lateral to the inferior epigastric vessels 
E. Most common type of inguinal hernia

Answer 18

A. Acquired type

Direct hernia- acquired type; more common in elderly; never enters the scrotum; neck of the sac is wide.

Question 19

Which of the following statements favors gastric ulcer over duodenal ulcer?
A. Perforated ulcer may erode into the left gastric artery
B. Perforated ulcer may erode into gastroduodenal artery
C. Majority of ulcers occur in the stomach.
D. increased risk in patients with blood type O
E. A and C

Answer 19

A. Perforated ulcer may erode into the left gastric artery

• Perforated duodenal ulcers may erode into the gastroduodenal artery.
• Majority of ulcers are in the duodenum and patients with
• Type O blood has increased risk for duodenal ulcer.

Question 20

Which embryological organ- adult counterpart is correctly paired?
A. Foramen ovale-foramen rotundum
B. Urachus-medial umbilical ligament
C. Umbilical vein-ligamentum teres
D. Umbilical artery-ligamentum venosum 
E. Ductus arteriosus-duct of rivinus

Answer 20

C. Umbilical vein-ligamentum teres

• Foramen ovale-fossa ovalis;
• Urachus- median umbilical ligament;
• Umbilical artery-medial umbilical ligament;
• Ductus arteriosus-ligamentum arteriosum

Question 21

In emergency surgery due to traumatic liver injury, the surgeon did a pringle maneuver. However, bleeding was not controlled and the patient was still bleeding profusely. What could be the other sources of bleeding?
A. Hepatic veins or IVC
B. Renal vein
C. Inferior pancreaticoduodenal artery 
D. Gastroepiploic arteries
E. Short gastric arteries

Answer 21

A. Hepatic veins or IVC

If during traumatic liver injuries, a pringle maneuver is done to determine probable source of bleeding. If the pringle maneuver controls bleeding, portal vein or hepatic artery is the likely cause. However if it fails to control the bleeding, other sources are entertained (IVC, hepatic veins)