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anatomy 1 a
mcq for MRCS part 1
|A 19 year old female is admitted with suspected meningitis. The House Officer is due to perform a lumbar puncture. What is the most likely structure first encountered when the needle is inserted?
|A. Ligamentum flavum B. Denticulate ligament C. Dural sheath D. Pia Mater E. Supraspinous ligament - correct answer
|In which level is lumbar puncture needle inserted?
|termination of spinal cord at which level? (adult)
|structures pierced by LP needle in order?
|1)skin 2)superficial fascia 3)supraspinous ligament 4)interspinous ligament 5)ligamentum flavum 6)epidural venous sinus containing vertebral venous plexus 7)duramater 8)arachnoid mater
|A 34 year old male is being examined in the pre-operative assessment clinic. A murmur is identified in the 5th intercostal space just next to the left side of the sternum. From where is it most likely to have originated?
|A. Mitral valve B. Aortic valve C. Pulmonary valve D. Right ventricular aneurysm E. Tricuspid valve - correct answer
|sites of auscultation of heart sound?
|1.Pulmonary valve Left second intercostal space, at the upper sternal border 2.Aortic valve Right second intercostal space, at the upper sternal border 3.Mitral valve Left fifth intercostal space, just medial to mid clavicular line 4.Tricuspid valve L
|1.Pulmonary valve location
|1.Pulmonary valve Left second intercostal space, at the upper sternal border
|Aortic valve location
|Aortic valve Right second intercostal space, at the upper sternal border
|Mitral valve location
|Mitral valve Left fifth intercostal space, just medial to mid clavicular line
|tricuspid valve location
|Left fifth intercostal space, at the lower left sternal border
|What is the correct embryological origin of the stapes?
|A. First pharyngeal arch B. Second pharyngeal arch - correct ans C. Third pharyngeal arch D. Fourth pharyngeal arch E. Fifth pharyngeal arch
|pharyngeal arch develop at which week of embryonic growth?
|pharyngeal arch develop at 4th week of embryonic growth from which outpouching?
|how many pharyngeal arch?
|6 but 5th is absent or fuses with 6th
|first pharyngeal arch gives rise to what structure
|M's and T's Structure 1)Muscle of mastication 2)mylohyoid 3)tensor tympani 4)tensor veli palaetini 5)anteroior belly of digastric 6)maxilla 7)malleus 8)incus 9)maxillary artery branch of ECA 10)mandibular nerve
|2nd pharyngeal arch gives rise to what structure
|S for second stapediys muscle stylohyoid muscle muscle of facial expression buccinator platysma post belly of digastric stapes styloid process upper body of hyoid lesser horn of hyoid inf branch of sup thyroid artery facial n stapedial ar
|3rd pharyngeal arch gives rise to what structure
|stylopharyngeus muscle glosssopharyngeal n greter horn and lower part of hyoid thymus and inf parathyroid common and internal carotid art
|4th pharyngeal arch gives rise to what structure
|Cricothyroid All intrinsic muscles of the soft palate Thyroid and epiglottic cartilages Superior parathyroids Right- subclavian artery, Leftaortic arch vagus
|6th pharyngeal arch gives rise to what structure
|All intrinsic muscles of the larynx (except cricothyroid) Cricoid, arytenoid and corniculate cartilages Right Pulmonary artery, Left- Pulmonary artery and ductus arteriosus recurrent laryngeal nerve and vagus nerve
|Which muscle initiates abduction of the shoulder?
|chief abductor of the humerus
|initiator of abduction
|common form of rotator cuff disease
|rotator cuff muscle origin and insertion
|origin - scapula insertion - greater tuberosity except subscapularis in lesser tuberosity
|long head of triceps attached where
|long head of biceps arises from
|from the supraglenoid tubercle
|Fibrous capsule of shoulder attaches to
|scapula and to the labrum humerus at the level of the anatomical neck
|The inferior extension of the fibrous capsule of shoulder is closely related to
|axillary nerve injured in what type of dislocation commonly
|Flexion of shoulder joint
|Anterior part of deltoid Pectoralis major Biceps Coracobrachialis
|extension of shoulder joint
|Posterior deltoid Teres major Latissimus dorsi
|Adduction of shoulder joint
|Pectoralis major Latissimus dorsi Teres major Coracobrachialis
|Abduction of shoulder joint
|Mid deltoid Supraspinatus
|Medial rotation of shoulder joint
|Subscapularis Anterior deltoid Teres major Latissimus dorsi
|Lateral rotation of shoulder joint
|Posterior deltoid Infraspinatus Teres minor
|Anterior to shoulder .. which vessels or nerve
|Brachial plexus Axillary artery and vein
|posterior to shoulder .. which vessels or nerve
|Suprascapular nerve Suprascapular vessels
|Inferior to shoulder .. which vessels or nerve
|Axillary nerve Circumflex humeral vessels
|What is the most important structure involved in supporting the uterus?
|central perineal tendon
|supports of the uterus include
|central perineal tendon (the most important) lateral cervical -a round and uterosacral ligaments- b a and b are condensation of endopelvic fascia
|blood supply of uterus
|uterine artery anastomose with
|ovarian artery (superiorly)
|ureter closely related to which artery
|uterine artery br of internal iliac
|A 22 year old man suffers a compound fracture of the tibia. During attempted surgical repair the deep peroneal nerve is divided. Which of the following muscles will not be affected as a result?
|A. Tibialis anterior B. Peroneus longus - correct answer C. Extensor hallucis longus D. Extensor digitorum longus e. peroneus tertius
|Peroneus longus is innervated by
|superficial peroneal nerve (L4, L5, S1).
|Deep peroneal nerve Origin
|common peroneal nerve, at the lateral aspect of the fibula, deep to peroneus longus
|Nerve root values deep peroneal nerve
|L4, L5, S1, S2
|Course and relation of deep peroneal nerve
|Pierces the anterior intermuscular septum to enter the anterior compartment of the lower leg • Passes anteriorly down to the ankle joint, midway between the two malleoli• Terminates In the dorsum of the foot
|Muscles innervated by deep peroneal nerve
|Tibialis anterior • Extensor hallucis longus • Extensor digitorum longus • Peroneus tertius • Extensor digitorum brevis
|Cutaneous innervation of deep peroneal nerve
|Web space of the first and second toes
|Actions of deep peroneal nerve
|Dorsiflexion of ankle joint • Extension of all toes (extensor hallucis longus and extensor digitorum longus) • Eversion of the foot
|lateral branch of the deep peroneal nerve innervate
|innervates the extensor digitorum brevis and the extensor hallucis brevis
|medial branch of deep peroneal nerve supplies
|the web space between the first and second digits.
|A 56 year old man is undergoing a superficial parotidectomy for a pleomorphic adenoma. During the dissection of the parotid, which of the following structures will be encountered lying most superficially?
|Most superficial structure on the parotid gland
|= facial nerve
|deeper to this facial nerve in parotid gland lies
|the retromandibular vein arterial layer lies deeply.
|Anatomy of the parotid gland and Location
|Overlying the mandibular ramus; anterior and inferior to the ear
|Structures passing through the parotid gland
|• Facial nerve (Mnemonic: The Zebra Buggered My Cat; Temporal Zygomatic, Buccal, Mandibular, Cervical) • External carotid artery • Retromandibular vein • Auriculotemporal nerve
|Arterial supply of parotid
|Branches of external carotid artery
|venous supply of parotid
|nerve supply of parotid
|Parasympathetic-Secretomotor • Sympathetic-Superior cervical ganglion • Sensory- Greater auricular nerve
|Lymphatic drainage of parotid
|Deep cervical nodes
|Parasympathetic stimulation of parotid produces what type of saliva
|water rich, serous saliva
|sympathetic stimulation of partoid produces what type of saliva
|low volume, enzyme-rich saliva
|A 43 year old man is stabbed outside a nightclub. He suffers a transection of his median nerve just as it leaves the brachial plexus. Which of the following features is least likely to ensue?
|A. Ulnar deviation of the wrist B. Complete loss of wrist flexion - correct answer C. Loss of pronation D. Loss of flexion at the thumb joint E. Inability to oppose the thumb
|Loss of the median nerve will result in loss of function of the .....muscles
|result in loss of function of the flexor muscles
|Loss of the median nerve will result in loss of function of the flexor muscle but which other muscle still function
|flexor carpi ulnaris will still function and produce ulnar deviation and some residual wrist flexion
|High median nerve lesions result in
|complete loss of flexion at the thumb joint.
|median nerve is formed by union of
|lateral and medial root respectively
|cource of median nerve
|1)passes between the two heads of PT muscle, runs on the deep surface of FDS 2)Near the wrist becomes superficial betweentendons of FDS and FCR, then deep to palmaris longus tendon 3)passes deep to the Flex Retinaculum to enter the palm
|supply of median nerve in forearm
|Pronator teres Flexor carpi radialis Palmaris longus Flexor digitorum superficialis Flexor pollicis longus Flexor digitorum profundus (only the radial half)
|supply of median nerve in distal forearm
|Palmar cutaneous branch
|supply of median nerve in Hand (Motor)
|Motor supply (LOAF) • Lateral 2 lumbricals • Opponens pollicis • Abductor pollicis brevis • Flexor pollicis brevis
|supply of median nerve in Hand (sensory)
|Over thumb and lateral 2 ½ fingers • On the palmar aspect this projects proximally, on the dorsal aspect only the distal regions are innervated with the radial nerve providing the more proximal cutaneous innervation.
|median nerve damage at wrist causes
|Damage at wrist • e.g. carpal tunnel syndrome • paralysis and wasting of thenar eminence muscles and opponens pollicis (ape hand deformity) • sensory loss to palmar aspect of lateral (radial) 2 ½ fingers
|median nerve Damage at elbow
|Damage at elbow, as above plus: • unable to pronate forearm • weak wrist flexion • ulnar deviation of wrist
|Anterior interosseous nerve (branch of median nerve) damage causes
|leaves just below the elbow • results in loss of pronation of forearm and weakness of long flexors of thumb and index finger
|78 year old man is due to undergo an endarterectomy of the internal carotid artery. Which of the following nervous structures are most at risk during the dissection?
|A. Recurrent laryngeal nerve B. Sympathetic chain C. Hypoglossal nerve - correct answer D. Phrenic nerve E. Lingual nerve
|Nerves at risk during a carotid endarterectomy: •
|Hypoglossal nerve • Greater auricular nerve • Superior laryngeal nerve (HSG)
|internal carotid artery is formed from
|common carotid opposite the upper border of the thyroid cartilage.
|branches of internal carotid artery
|Branches • Anterior and middle cerebral artery • Ophthalmic artery • Posterior communicating artery • Anterior choroid artery • Meningeal arteries • Hypophyseal arteries
|Which of the following structures is not transmitted by the jugular foramen?
|A. Hypoglossal nerve -correct ans B. Accessory nerve C. Internal jugular vein D. Inferior petrosal sinus e. vagus
|Contents of the jugular foramen:
|1)Anterior: inferior petrosal sinus 2)Intermediate: glossopharyngeal, vagus, and accessory nerves 3)Posterior: sigmoid sinus (becoming the internal jugular vein) and some meningeal branches from the occipital and ascending pharyngeal arteries
|Foramen ovale content
|1Otic ganglion 2) V3 (Mandibular nerve:3rd branch of trigeminal) 3) Accessory meningeal artery 4)Lesser petrosal nerve 5)Emissary veins
|Foramen spinosum content
|1)Middle meningeal artery (MMA) 2)Meningeal branch of the Mandibular nerve
|Foramen rotundum content
|Maxillary nerve (V2)
|Foramen lacerum content
|Base of the medial pterygoid plate. Internal carotid artery Nerve and artery of the pterygoid canal
|Foramen magnum content
|Anterior and posterior spinal arteries Vertebral arteries Medulla oblongata
|Stylomastoid foramen content
|Stylomastoid artery Facial nerve
|Superior orbital fissure content
|(1) Oculomotor nerve (III) (2) trochlear nerve (IV) (3)lacrimal, frontal and nasociliary branches of ophthalmic nerve (V1) (4)abducent nerve (VI) (5)Superior and inferior ophthalmic vein
|Which of the following fascial structures encases the apex of the lungs?
|A. Waldeyers fascia B. Sibsons fascia -correct answer C. Pretracheal fascia D. Clavipectoral fascia E. None of the above
|Sibson's fascia overlies
|apices of both lungs
|The suprapleural fascia also known as
|(Sibson's fascia) runs from C7 to the first rib and overlies the apex of both lungs.
|C7 to the first rib and overlies the apex of both lungs.
|sibson's fascia lies where
|it lies between the parietal pleura and the thoracic cage.
|The left lung has how many lobes
|two lobes dividedby the lingula.
|The right lung is composed of how many lobes
|3 lobes divided by the oblique and transverse fissures.
|apex of both lungs is situated where
|approximately 4cm superior to the sterno-costal joint of the first rib
|Inferior borders of both lungs location
|· 6th rib in mid clavicular line · 8th rib in mid axillary line · 10th rib posteriorly
|The pleura runs how many ribs lower than the corresponding lung level.
|With regards to the jugular vein, which of the following statements is untrue?
|A. It lies within the carotid sheath B. It is the continuation of the sigmoid sinus C. The terminal part of the thoracic duct crosses anterior to it to insert into the right subclavian vein D. The hypoglossal nerve is closely related to it as it passe
|Each jugular vein begins in the.....
|jugular vein are the continuation of the .......
|jugular vein terminate in the .....end of clavicle
|jugular vein terminate in the medial end of clavicle where they unite with...
|jugular vein lies inside ....... during the entire cource
|Below the skull the internal carotid artery and last four cranial nerves are anteriomedial to the .......vein.
|on left side jugular vein related to....
|A 28 year old man requires a urethral catheter to be inserted prior to undergoing a splenectomy. Where is the first site of resistance to be encountered on inserting the catheter?
|A. Bulbar urethra B. Membranous urethra - correct answer C. Internal sphincter D. Prostatic urethra E. Bladder neck
|The.................. is the least distensible portion of the urethra.
|The membranous utrethra is the least distensible portion of the urethra. why?
|fact that it is surrounded by the external sphincter.
|The female urethra is ............. than the male urethra
|shorter and more acutely angulated
|neck of the bladder is subjected to transmitted intraabdominal pressure and therefore deficiency in this area may result in
|stress urinary incontinence.
|Pre-prostatic urethra location
|between the bladder and prostate gland
|Pre-prostatic urethra length
|between 1 and 1.5cm long.
|Pre-prostatic urethra innervation
|Innervated by sympathetic noradrenergic fibres, as this region is composed of striated muscles bundles
|Pre-prostatic urethra prevents
|retrograde ejaculation (by contraction of itself)
|Prostatic urethra contains
|several opening for transmission of semen
|Membranous urethra is ... part of urethra
|Narrowest part of the urethra and surrounded by external sphincter
|Narrowest part of the urethra
|Membranous urethra surounded by
|Membranous urethra traverses perineal membrane where....
|2.5cm postero-inferior to the symphysis pubis
|Penile urethra travels through where
|the corpus songiosum on the underside of the penis.
|Penile urethra is the (long /short) urethral segment?
|longest urethral segment.
|transitional in nature, squamous more distally.
|bulbo-urethral glands open where ....
|into the spongiose section of the urethra 2.5cm below the perineal membra
|longest urethral segment.
|A 23 year old man undergoes an orchidectomy. The right testicular vein is ligated; into which structure does it drain?
|A. Right renal vein B. Inferior vena cava- correct answer C. Common iliac vein D. Internal iliac vein
|testicular vein drainage
|The pampiniform plexus drains to the testicular vein. The left testicular vein drains into the left renal vein. The right testicular vein drains into the inferior vena cava.
|Spermatic cord is formed
|by the vas deferens
|Internal spermatic fascia origin..
|Cremasteric fascia origin
|From the fascial coverings of internal oblique
|External spermatic fascia origin
|from External oblique aponeurosis
|Artery of vas deferens arises from (branch of)
|Arises from inferior vesical artery
|Cremasteric artery arises from(branch of)
|Arises from inferior epigastric
|Pampiniform plexus Venous plexus, drains into
|right or left testicular vein
|Genital branch of the genitofemoral nerve Supplies
|Testicular artery Branch of abdominal aorta supplies
|testis and epididymis
|Vas deferens Transmits ....
|sperm and accessory gland secretions
|scrotum composed of
|skin and attached daros fascia
|scrotum arterial supply
|Arterial supply from the anterior and posterior scrotal arteries
|scrotum lumphatic drainage
|Lymphatic drainage to the inguinal lymph nodes
|scrotum parietal layer
|Parietal layer of the tunica vaginalis is the innermost layer
|testes surrounded by
|The testes are surrounded by the tunica vaginalis (closed peritoneal sac).
|The testicular arteries arise from
|the aorta immediately inferiorly to the renal arteries.
|testes lymphatic drainage
|Lymphatic drainage is to the para-aortic nodes.
|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?
|A. From its proximal medial border B. From its proximal lateral border C. From its proximal posterior surface D. From the proximal end E. From the distal end - correct answer
|The blood supply to the scaphoid enters from...
|non articular surface near its distal end
|Transverse fractures through the scaphoid therefore carry a risk ....
|scaphoid has a concave articular surface for
|the head of the capitate
|scaphoid has a crescentic surface for
|corresponding area on the lunate.
|scaphoid proximally has a wide convex articular surface with the
|The only part of the scaphoid that is available for the entry of blood vessels.
|tubercle of scaphoid is commonly fractured and results in
|A 21 year old man has an inguinal hernia and is undergoing a surgical repair. As the surgeons approach the inguinal canal they expose the superficial inguinal ring. Which of the following forms the lateral edge of this structure?
|A. Inferior epigastric artery B. Conjoint tendon C. Rectus abdominis muscle D. External oblique aponeurosis - correct answer E. Transversalis fascia
|the anterior wall of the inguinal canal formed by
|external oblique aponeurosis and Superficial inguinal ring
|posteromedially boarder of inguinal canal
|posterior boarder of inguinal canal
|Roof of inguinal canal
|Internal oblique · Transversus abdominis
|Medial boarder of inguinal canal
|· External ring · Conjoint tendon
|floor of inguinal canal formed by
|· External oblique aponeurosis · Inguinal ligament · Lacunar ligament
|content of inguinal canal
|Males- Spermatic cord and ilioinguinal nerve Female - Round ligament of uterus and ilioinguinal nerve
|covering of spermatic cord
|spermatic cord has 3 coverings: · External spermatic fascia from external oblique aponeurosis · Cremasteric fascia · Internal spermatic fascia
|medially- rectus abdominis laterally - inferior epigastric artery below - inguinal ligament
|Which of the following cranial venous sinuses is unpaired?
|A. Transverse sinus B. Superior sagittal sinus - correct answer C. Cavernous sinus D. Sigmoid sinus E. Inferior petrosal sinus
|superior sagittal sinus begins at
|..............link the superior sagittal sinus with the veins on the exterior of the cranium.
|parietal emissary veins
|cranial venous sinuses are located
|within the dura mater
|cranial venous sinus have ..... valve
|Which of the following laryngeal tumours will not typically metastasise to the cervical lymph nodes?
|A. Glottic- correct answer B. Supraglottic C. Subglottic D. Transglottic E. Aryepiglottic fold
|lymphatic drainage of vocal cord
|no lymphatic drainage
|supraglottic part of larynx drain to
|upper deep cervical nodes through vessels piercing the thyrohyoid membrane.
|sub glottic part drains to
|pre laryngeal, pre tracheal and inferior deep cervical nodes.
|aryepiglottic and vestibular folds have a .... lymphatic drainage and will metastasise .....
|laynx location correspondigly
|C3 to C6 vertebral bodies.
|(muscle)Posterior cricoarytenoid origin
|posterior aspect of lamina of cricoid
|laryngeal cavity extends from
|aryngeal inlet to the level of the inferior border of the cricoid cartilage
|layngeal cartilage paired
|Three of these are paired; arytenoid, corniculate and cuneiform.
|layngeal cartilage unpaired
|single : thyroid, cricoid and epiglottic
|(muscle)Posterior cricoarytenoid nerve supply
|recurrent laryngeal nerve
|Which of the following forms the medial wall of the femoral canal?
|A. Pectineal ligament B. Adductor longus C. Sartorius D. Lacunar ligament - correct answer E. Inguinal ligament
|The femoral canal lies at the ........ aspect of the femoral sheath.
|femoral sheath contains
|femoral artery ---laterally femoral vein--- medially
|Borders of the femoral canal
|Laterally Femoral vein Medially Lacunar ligament Anteriorly Inguinal ligament Posteriorly Pectineal ligament
|Contents of femoral canal
|· Lymphatic vessels · Cloquet's lymph node
|femoral canal allows femoral vein to expand because
|for increased venous return to the lower limbs.
|femoral hernia have high risk for .......
|A 67 year old man is undergoing a transurethral resection of a bladder tumour using diathermy. Suddenly during the procedure the patients leg begins to twitch. Stimulation of which of the following nerves is the most likely cause?
|A. Femoral B. Pudendal C. Sciatic D. Obturator - correct answer E. Gluteal
|The obturator nerve arises from
|L2, L3 and L4 by branches from the ventral divisions of each of these nerve roots L3 - main contribution L2 - Ocassionally absent
|Obturator nerve supplies
|Muscles supplied: external obturator, adductor longus, adductor brevis, adductor magnus (not the lower partsciatic nerve), gracilis,skin and fascia of the distal two thirds of the medial aspect of thigh
|A 5 year old boy is playing with some small ball bearings. Unfortunately he inhales one. To which of the following lung regions is the ball most likely to settle?
|A. Right lower lobe - correct answer B. Left main bronchus C. Right upper lobe D. Left lower lobe E. None of the above
|root of the left lung passes under the ...... and in front of the .........
|aortic arch , descending aorta
|A patient presents with superior vena caval obstruction. How many collateral circulations exist as alternative pathways of venous return?
|A. None B. One C. Two D. Three E. Four - correct answer
|name of 4 collateral venous systems
|Azygos venous system · Internal mammary venous pathway · Long thoracic venous system with connections to the femoral and vertebral veins (2 pathways)
|although venous system are present what might still occur
|Superior vena cava Drainage
|·Head and neck · Upper limbs · Thorax · Part of abdominal walls
|Subclavian and internal jugular veins unite to form
|right and left brachiocephalic veins
|right and left brachiocephalic veins unite to form
|..... vein joins ..... before it enters right atrium
|Azygos vein joins the SVC
|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?
|A. Pterygopalatine ganglion - correct answer B. Otic ganglion C. Submandibular ganglion D. Ciliary ganglion E. None of the above
|The parasympathetic fibres to the lacrimal apparatus transit via
|the pterygopalatine ganglion.
|The ducts of the lacrimal gland open into
|Those from the orbital part penetrate the aponeurosis of levator palpebrae superioris to join those from the palpebral part
|Therefore excision of the palpebral part of lacrimal gland is functionally similar to excision of
|the entire lacrimal gland.
|Blood supply of lacrimal gland
|Lacrimal branch of the opthalmic artery.
|Venous drainage is of lacrimal gland
|superior opthalmic vein
|The lacrimal gland is innervated by
|the secretomotor paraympathetic fibres from the pterygopalatine ganglion
|Nasolacrimal duct opens in
|inferior meatus of nose
|Which of the nerves listed below is responsible for the innervation of the lateral aspect of flexor digitorum profundus?
|Anterior interosseous nerve
|anterior interosseous nerve is a branch of
|anterior interosseous nerve is responsible for innervation of ...
|lateral aspect of the flexor digitorum profundus.
|A 45 year old lady is undergoing a Whipples procedure for carcinoma of the pancreatic head. The bile duct is transected. Which of the following vessels is mainly responsible for the blood supply to the bile duct?
|bile duct has an axial blood supply which is derived from
|hepatic artery and from retroduodenal branches of the gastroduodenal artery
|In liver there is contribution by the portal vein to the
|blood supply of the bile duct
|Damage to the hepatic artery during a difficult cholecystectomy is a recognised cause of
|bile duct stricture
|arterial supply of GB
|Cystic artery (branch of Right hepatic artery)
|venous drainage of GB
|Nerve supply of GB
|Sympathetic- mid thoracic spinal cord Parasympathetic- anterior vagal trunk
|Common bile duct Origin
|Confluence of cystic and common hepatic ducts
|Arterial supply of Bile duct
|Branches of hepatic artery and retroduodenal branches of gastroduodenal artery
|Medially- Common hepatic duct Inferiorly- Cystic duct Superiorly- Inferior edge of liver Contents -Cystic artery
|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
|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.
|Anterior triangle of the neck Boundaries
|Anterior border of the Sternocleidomastoid Lower border of mandible Anterior midline
|Sub triangles of anterior triangle of neck divided by
|Digastric above and Omohyoid
|· Muscular triangle: Neck strap muscles · Carotid triangle: Carotid sheath · Submandibular Triangle (digastric)
|Neck strap muscles
|Digastric triangle contents
|Submandibular gland Submandibular nodes Facial vessels hypoglossal nerve
|Muscular triangle contents
|Strap muscles External jugular vein
|Carotid triangle contents
|Carotid sheath (Common carotid, vagus and internal jugular vein) Ansa cervicalis
|anterior triangle consists of
|digastric triangle muscular triangle carotid triangle
|Nerve supply to digastric muscle
|Anterior: Mylohyoid nerve Posterior: Facial nerve
|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?
|The appendix is derived from
|appendix is derived from the midgut which is why .......
|early appendicitis may present with periumbilical
|Base of caecum.
|Up to 10cm long.
|lymphoid tissue(Hence mesenteric adenitis may mimic appendicitis)
|appendix blood supply
|Arterial supply: Appendicular artery (branch of the ileocolic).
|Caecal taenia coli converge at
|base of appendix (helps to identify appendix)
|appendix is .....peritoneal
|It is intra peritoneal.
|1/3 of the way along a line drawn from the Anterior Superior Iliac Spine to the Umbilicus
|commonest position of appendix -1st and 2nd
|retrocaecal-1st , pelvic- 2nd
|posititons of appendix
|Retrocaecal 74% · Pelvic 21% · Postileal · Subcaecal · Paracaecal · Preileal
|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?
|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 lingual nerve is probably at greater risk of injury during submandibular dissection but
|it is sensory
|Submandibular duct also known as
|submandibular duct (or wharton's duct) opens where?
|Opens lateral to the lingual frenulum on the anterior floor of mouth.
|what is the length of submandibular duct?
|5 cm length
|which nerve winds around whartons or submandibular duct?
|Lingual nerve wraps around Wharton's duct
|Innervation of submandibular duct?
|Sympathetic innervation- Superior Cervical ganglion via the Lingual nerve · Parasympathetic innervation- Submandibular ganglion
|Arterial supply of submandibular duct
|Branch of the Facial artery.
|Venous drainage of submandibular duct
|Anterior Facial vein (lies deep to the Marginal Mandibular nerve)
|Lymphatic drainage of submandibular duct
|Deep cervical and jugular chains of nodes
|You decide to take an arterial blood gas from the femoral artery. Where should the needle be inserted to gain the sample?
|Mid inguinal point
|mid inguinal point in the surface marking for
|Femoral triangle Boundaries Superiorly
|Femoral triangle Boundaries Laterally
|Femoral triangle Boundaries Medially
|Femoral triangle Boundaries Floor
|Iliopsoas, adductor longus and pectineus
|Femoral triangle Boundaries Roof
|· Fascia lata and Superficial fascia · Superficial inguinal lymph nodes (palpable below the inguinal ligament) · Great saphenous vein
|Femoral triangle content
|· Femoral vein (medial to lateral) · Femoral artery-pulse palpated at the mid inguinal point · Femoral nerve · Deep and superficial inguinal lymph nodes · Lateral cutaneous nerve · Great saphenous vein · Femoral branch of the genitofemoral nerve
|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 vagus
|only damage to the ........ nerve would account for difficulties in speech in/after carotid surgery
|vagus supplies ... pharyngeal arch ........ sections of the embryonic gut tube.
|-fourth and sixth pharyngeal arches. -fore and midgut section
|efferent fiber of vagus. 2 main type:
|-preganglionic parasympathetic fibres that innervate smooth muscle of the innervated organs (such as gut) -direct skeletal muscle innervation, largely to the muscles of the larynx and pharynx.
|vagus carries afferent fiber from what structures:
|afferent fibres from these areas (viz; pharynx, larynx, oesophagus, stomach, lungs, heart and great vessels)
|branches of vagus
|superior ganglion inferior ganglion Superior and inferior cervical cardiac branches Right recurrent laryngeal nerve Left recurrent laryngeal nerve Thoracic and cardiac branches
|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?
|External oblique aponeurosis
|anterior wall of inguinal canal
|external oblique aponeurosis.
|posterior wall of inguinal canal
|transversalis fascia and conjoint tendons
|External oblique muscle origin
|Outer surfaces of the lowest eight ribs
|External oblique muscle insertion
|· Anterior two thirds of the outer lip of the iliac crest. · The remainder becomes the aponeurosis that fuses with the linea alba in the midline.
|External oblique muscle Nerve supply
|Ventral rami of the lower six thoracic nerves
|External oblique muscle action
|Contains the abdominal viscera, may contract to raise intra abdominal pressure. Moves trunk to one side.
|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?
|Common peroneal nerve
|The contents of the popliteal fossa are (from medial to lateral):
|M ---> L Popliteal artery Popliteal vein Tibial nerve Common peroneal nerve
|sural nerve is a branch of
|sural nerve arises from
|inferior aspect of the popliteal fossa
|popliteal fossa boundries
|look in the figure from google!!!!
|content of popliteal fossa
|· Popliteal artery and vein · Small saphenous vein · Common peroneal nerve · Tibial nerve · Posterior cutaneous nerve of the thigh · Genicular branch of the obturator nerve · Lymph nodes
|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 affected at this level?
|Superior mesenteric artery
|Inferior phrenic level
|T12 Upper boarder
|Coeliac artery level
|Superior mesenteric artery level
|Middle suprarenal artery level
|Renal artery level
|Gonadal artery level
|Lumbar artery level
|Inferior mesenteric artery level
|Median sacral artery level
|Common iliac artery level
|unpaired abdominal aortic branches
|coeliac superior mesentric inferior mesentric median sacral
|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?
|chorda tympani supply
|It distributes taste fibres to the anterior two thirds of the tongue.
|facial nerve is the main nerve supplying the structures of the ......embryonic branchial arch.
|facial nerve supply
|Face ear taste tear · Face: muscles of facial expression · Ear: nerve to stapedius · Taste: supplies anterior two-thirds of tongue · Tear: parasympathetic fibres to lacrimal glands, also salivary glands
|facial nerve Enters parotid gland and divides into ... branches and they are
|· Temporal branch · Zygomatic branch · Buccal branch · Marginal mandibular branch · Cervical branch
|In the facial canal facial nerve has how many branches and what are they?
|- 3 branches: 1. greater petrosal nerve 2. nerve to stapedius 3. chorda tympani
|The first root of the brachial plexus commonly arises at which of the following levels?
|BRACHIAL PLEXUS ANATOMY
|KNOW IT FROM THE FIGURE BY DRAWING IT
|What is the anatomical level of the transpyloric plane?
|Structures that are at the level 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
|A 35 year old man falls and sustains a fracture to the middle third of his clavicle. Which vessel is at greatest risk of injury?
|subclavian vein lies behind .....
|subclavius and the medial part of the clavicle
|DRAW THE FIGURE SHOWING ORIGIN AND INSERTION OF MUSCLE IN CLAVICLE FROM NETTERS
|DRAW THE FIGURE SHOWING ORIGIN AND INSERTION OF MUSCLE IN CLAVICLE FROM NETTERS
|A 53 year old man with end stage mitral valve stenosis is undergoing a mitral valve replacement. The heart is opened and the musculi pectinati are identified. Where are these structures located?
|reason that the atrial walls in the right atrium are irregular anteriorly
|musculi pectinati are found in the atria
|musculi pectinati of the atria found in
|anterolateral surface of the chambers
|The musculi pectinati of the atria are only present in
|area derived from the embryological true atrium
|heart and roots of the great vessels within the pericardial sac are related anteriorly to
|sternum, medial ends of the 3rd to 5th ribs on the left and their associated costal cartilages
|The heart and pericardial sac are situated
|obliquely two thirds to the left and one third to the right of median plane
|Coronary sinus lies in
|posterior part of the coronary groove and receives blood from the cardiac veins
|Right coronary artery arises from
|the right aortic sinus
|left coronary artery derived from
|left aortic sinus
|comparison of right and left ventricle
|left ventricle is twice as thick as right In left ventricle - Mitral (double leaflet)
|· Right atrium · Diaphragmatic part of the left ventricle · Usually the posterior third of the interventricular septum · The sino atrial node (60% cases) · The atrio ventricular node (80% cases)
|· Left atrium · Most of left ventricle · Part of the right ventricle · Anterior two thirds of the inter ventricular septum · The sino atrial node (remaining 40% cases)
|innervation of the heart
|1) Autonomic nerve fibres from the superficial and deep cardiac plexus. 2)The parasympathetic supply to the heart is from presynaptic fibres of the vagus nerves.
|cusps of valce
|mitral valve 2 other valve 3 cusps
|which heart valve are attached to chordae tendinae
|mitral and tricuspid
|A 33 year old man sustains an injury to his forearm and wrist. When examined in clinic he is unable to adduct his thumb. What is the most likely underlying nerve lesion?
|Deep branch of the ulnar nerve
|Damage to the deep branch of the ulnar nerve may result in
|inability to adduct the thumb
|inability to adduct the thumb is tested clinicall by (function of ADDUCTOR POLLICIS is tested by)
|tested clinically by trying to withdraw a piece of paper from a patients hand grasped between thumb and index finger.
|origin of ADDUCTOR POLLICIS muscle
|Tendon sheath of flexor carpi radialis Bases of second, third and fourth metacarpals Anterior aspect of the trapezoid and capitate bones Transverse head comes from the longitudinal ride of the third metacarpal
|insertion of ADDUCTOR POLLICIS muscle
|Fibres of the two heads converge on insertion into the ulnar aspect of the base of the proximal phalanx of the thumb
|nerve supply of adductor pollicis muscle
|Deep branch of the ulnar (C8, T1)
|action of adductor pollicis muscle
|Adducts the thumb into the plane of the palm and draws it to the midline
|A 34 year old lady suffers from hyperparathyroidism. The right inferior parathyroid is identified as having an adenoma and is scheduled for resection. From which of the following embryological structures is it derived?
|Third pharyngeal pouch
|inferior parathyroid is a derivative of
|third pharyngeal pouch
|superior parathyroid originates from
|fourth pharyngeal pouch
|what does the parathyroid gland lie inside?
|· Four parathyroid glands · They lie within the pretracheal fascia
|parathyroids develop from
|third and fourth pharyngeal pouches
|parathyroids derived from the fourth pharyngeal pouch are located more
|superiorly and associated with thyroid gland
|parathyoid derived from the third pharyngeal pouch lie more
|inferiorly and related to thymus
|blood supply to the parathyroid glands is derived from
|inferior and superior thyroid arteries
|Which of the following structures separates the subclavian artery and vein?
|Anterior scalene muscle
|what separates the subclavian vein (anterior) from the subclavian artery (posterior).
|anterior scalene muscle
|Scalene muscle origin
|Transverse processes C2 to C7
|Scalene muscle innervation
|Spinal nerves C4-6
|scalene muscle Insertion
|First and second ribs
|The brachial plexus and subclavian artery pass between the
|anterior and middle scalene through space called scalene hiatus/fissure
|The scalenes are at risk of adhering to the fascia surrounding the brachial plexus or shortening causing compression of the brachial plexus when it passes between the clavicle and 1st rib causing
|thoracic outlet syndrome
|A 33 year old man is stabbed in the right chest and undergoes a thoracotomy. The right lung is mobilised and the pulmonary ligament inspected. Which of the following structures does not lie within the pulmonary ligament of the right lung?
|pulmonary ligament is formed by
|pleural condensation at the hilum of the lung
|pulmonary ligament contains
|pulmonary vein, bronchus and trachea
|basilic vein drains into
|axillary vein is usually the commonest site following from the basilic for
|PICC line ending up
|basilic and cephalic veins continuous with
|palmar venous arch distally and axillary vein proximally
|A man requires long term parenteral nutrition and decision is made to insert a PICC line for long term venous access. it inserted into the basilic vein at the region of the elbow. cont... turn it
|As the catheter is advanced, into which venous structure is the tip of the catheter most likely to pass from the basilic vein? Axillary vein
|A 23 year old man is involved in a fight outside a nightclub and sustains a laceration to his right arm. On examination he has lost extension of the fingers in his right hand. What is the most likely nerve injury for the scenario given?
|radial nerve supplies
|the extensor muscle group
|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. what nerve is involved?
|The interossei are supplied by
|A 28 year old rugby player injures his right humerus and on examination is noted to have a minor sensory deficit overlying the point of deltoid insertion into the humerus. what nerve is involved?
|skin around the deltoid (humerus) is surrounded by
|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?
|how many branches does coeliac plexus have?
|3 branches a)hepatic artery b)gastroduodenal artery c)left gastric artery
|A 76 year old man complains of symptoms of claudication. cont..........
|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? Anterior tibial artery
|dorsalis pedis is a continuation of
|anterior tibial artery