anatomy 18.04

Question 1

At which level superior mesenteric artery branches from aorta?

Answer 1

L1

Question 2

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

Answer 2

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.

Question 3

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

Answer 3

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.

Question 4

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

Answer 4

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

Question 5

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

Answer 5

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

Question 6

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

Answer 6

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.

Question 7

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

C6

C2

C4

C3

C5

Answer 7

It enters the gland at C6.

Question 8

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

Answer 8

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.

Question 9

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

Answer 9

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.

Question 10

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

Answer 10

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:

Question 11

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

Answer 11

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.

Question 12

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

Answer 12

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.

Question 13

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

Answer 13

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.

Question 14

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

Answer 14

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.

Question 15

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

Answer 15

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

Question 16

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

Facial

Trigeminal

Hypoglossal

Vagus

Glossopharyngeal

Answer 16

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).

Question 17

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

Answer 17

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

Question 18

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

All metatarsals

5th metatarsal

Calcaneum

Medial cuneiform

3rd metatarsal

Answer 18

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

Question 19

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

Answer 19

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.

Question 20

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

Answer 20

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.

Question 21

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

Answer 21

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)

Question 22

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

Answer 22

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

Question 23

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

Answer 23

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)

Question 24

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

Answer 24

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

Question 25

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

Answer 25

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.