anatomy 19.04 Flashcards
A 32 year old lady is admitted with weakness, visual disturbance and peri orbital pain. On examination, she is noted to have mydriasis and diminished direct response to light shone into the affected eye. The consensual response is preserved when light is shone into the unaffected eye. Which of the cranial nerves listed below is responsible for the diminished direct response?
Abducens
Oculomotor
Optic
Trigeminal
Hypoglossal
This describes a relative afferent pupillary defect (RAPD). RAPD is a defect in the direct response to light. It is due to damage in optic nerve or severe retinal disease. If an optic nerve lesion is present the affected pupil will not constrict to light when light is shone in the that pupil during the swinging flashlight test. However, it will constrict if light is shone in the other eye (consensual response).
The most likely cause for this is an optic neuritis (not really surgical!). Other causes include ischemic optic disease or retinal disease, severe glaucoma causing trauma to optic nerve and direct optic nerve damage (trauma, radiation, tumor).
Which of the following statements relating to the basilar artery and its branches is false?
The superior cerebellar artery may be decompressed to treat trigeminal neuralgia
Occlusion of the posterior cerebral artery causes contralateral loss of the visual field
The oculomotor nerve lies between the superior cerebellar and posterior cerebral arteries
The posterior inferior cerebellar artery is the largest of the cerebellar arteries arising from the basilar artery
The labyrinthine branch is accompanied by the facial nerve
The posterior inferior cerebellar artery is the largest of the cerebellar arteries arising from the vertebral artery. The labyrinthine artery is long and slender and may arise from the lower part of the basilar artery. It accompanies the facial and vestibulocochlear nerves into the internal auditory meatus. The posterior cerebral artery is often larger than the superior cerebellar artery and it is separated from the vessel, near it’s origin, by the oculomotor nerve. Arterial decompression is a well established therapy for trigeminal neuralgia.
A sprinter attends A&E with severe leg pain. He had forgotten to warm up and ran a 100m sprint race. Towards the end of the race he experienced pain in the posterior aspect of his thigh. The pain worsens, localising to the lateral aspect of the knee. The sprinter is unable to flex the knee. What structure has been injured?
Anterior cruciate ligament
Posterior cruciate ligament
Semimembranosus tendon
Semitendinosus tendon
Biceps femoris tendon
The biceps femoris is commonly injured in sports that require explosive bending of the knee as seen in sprinting, especially if the athlete has not warmed up first. Avulsion most commonly occurs where the long head attaches to the ischial tuberosity. Injuries to biceps femoris are more common than to the other hamstrings.
Which of the following is a branch of the third part of the axillary artery?
Superior thoracic
Lateral thoracic
Dorsal scapular
Thoracoacromial
Posterior circumflex humeral
The other branches include:
Subscapular
Anterior circumflex humeral
The dorsal scapular artery arises from the third part of the subclavian artery in most cases
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 terminates by dividing into the superficial temporal and maxillary branches. The external carotid has eight branches, 3 from its anterior surface ; thyroid, lingual and facial. The pharyngeal artery is a medial branch. The posterior auricular and occipital are posterior branches.
‘Some Angry Lady Figured Out PMS’ (in order)
Superior thyroid (superior laryngeal artery branch)
Ascending pharyngeal
Lingual
Facial (tonsillar and labial artery)
Occipital
Posterior auricular
Maxillary (inferior alveolar artery, middle meningeal a.)
Superficial temporal
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 distally?
Quadriceps
Adductor longus
Adductor magnus
Pectineus
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 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 distally?
Quadriceps
Adductor longus
Adductor magnus
Pectineus
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 76 year old man is undergoing an abdominal aortic aneurysm repair. The surgeons occlude the aorta with two clamps, the inferior clamp being placed at the point of aortic bifurcation. Which of the following vertebral bodies will lie posterior to the clamp at this level?
L1
T10
L4
L5
L2
The aorta bifurcates at L4. An important landmark that is tested frequently.
A 21 year old man is hit with a hammer and sustains a depressed skull fracture at the vertex. Which of the following sinuses is at risk in this injury?
Superior sagittal sinus
Inferior petrosal sinus
Transverse sinus
Inferior sagittal sinus
Straight sinus
The superior sagittal sinus is at greatest risk in this pattern of injury. This sinus begins at the front of the crista galli and courses backwards along the falx cerebri. It becomes continuous with the right transverse sinus near the internal occipital protuberance.
The motor nucleus of cranial nerve V supplies all except which of the following muscles?
Masseter
Posterior belly of digastric
Temporalis
Tensor tympani
Tensor veli palatini
The posterior belly of digastric is supplied by the branchial motor component of the facial nerve. All of the other muscles are supplied by axons from the motor nucleus of cranial nerve V.
What is the lymphatic drainage of the female urethra?
Superficial inguinal nodes
Deep inguinal nodes
Internal iliac nodes
External iliac nodes
Para-aortic nodes
The entire female urethra drains to the internal iliac nodes.
The entire female urethra drains to the internal iliac nodes.
Loss of taste sensation from the posterior third of the tongue is most likely the result to an injury to which of the structures listed below?
Hypoglossal nerve
Chorda tympani nerve
Facial nerve
Mandibular branch of the trigeminal nerve
Glossopharyngeal nerve
The glossopharyngeal nerve supplies the taste and general sensation to the posterior third of the tongue.
A 56 year old man is undergoing an anterior resection for a carcinoma of the rectum. Which of the structures below is least likely to be encountered during the mobilisation of the anterior rectum?
Denonvilliers’ fascia
Middle sacral artery
Bladder
Rectovesical pouch
Seminal vesicles
With the exception of the middle sacral artery all of the other structures lie anterior to the rectum. They may all be palpated during digital rectal examination.
A 56 year old man is undergoing an anterior resection for a carcinoma of the rectum. Which of the structures below is least likely to be encountered during the mobilisation of the anterior rectum?
Denonvilliers’ fascia
Middle sacral artery
Bladder
Rectovesical pouch
Seminal vesicles
With the exception of the middle sacral artery all of the other structures lie anterior to the rectum. They may all be palpated during digital rectal examination.
A baby is found to have a Klumpke’s palsy post delivery. Which of the following is most likely to be present?
Loss of flexors of the wrist
Weak elbow flexion
Pronated forearm
Adducted shoulder
Shoulder medially rotated
Features of Klumpkes Paralysis
Claw hand (MCP joints extended and IP joints flexed)
Loss of sensation over medial aspect of forearm and hand
Horner’s syndrome
Loss of flexors of the wrist
A C8, T1 root lesion is called Klumpke’s paralysis and is caused by delivery with the arm extended.
