EMRCS ANATOMY 5 Flashcards
(50 cards)
How many compartments are there in the lower leg?
2 1 3 5 4
4
The posterior compartment of the lower leg has both superficial and deep posterior layers, together with the anterior and lateral compartments this allows for four compartments. Decompression of the deep posterior compartment during fasciotomy may be overlooked with significant sequelae.
Which structure is least likely to be found at the level of the sternal angle?
Left brachiocephalic vein Intervertebral discs T4-T5 Start of aortic arch 2nd pair of costal cartilages Bifurcation of the trachea into left and right bronchi
Left brachiocephalic vein
The left brachiocephalic vein lies posterior to the manubrium, at the level of its upper border. The sternal angle refers to the transition between manubrium and sternum and therefore will not include the left brachiocephalic vein.
A 53 year old man is undergoing a left hemicolectomy for carcinoma of the descending colon. From which embryological structure is this region of the gastrointestinal tract derived?
Vitellino-intestinal duct Hind gut Mid gut Fore gut Woolffian duct
Hind gut
The left colon is embryologically part of the hind gut. Which accounts for its separate blood supply via the IMA
What is the most useful test to clinically distinguish between an upper and lower motor neurone lesion of the facial nerve?
Blow cheeks out Loss of chin reflex Close eye Raise eyebrow Open mouth against resistance
Raise eyebrow
Upper motor neurone lesions of the facial nerve- Paralysis of the lower half of face.
Lower motor neurone lesion- Paralysis of the entire ipsilateral face.
An 18 year old man is stabbed in the axilla during a fight. His axillary artery is lacerated and repaired. However, the surgeon neglects to repair an associated injury to the upper trunk of the brachial plexus. Which of the following muscles is least likely to demonstrate impaired function as a result?
Palmar interossei Infraspinatus Brachialis Supinator brevis None of the above
Palmar interossei
The palmar interossei are supplied by the ulnar nerve. Which lies inferiorly and is therefore less likely to be injured.
A 23 year old man is involved in a fight, during the dispute he sustains a laceration to the posterior aspect of his right arm, approximately 2cm proximal to the olecranon process. On assessment in the emergency department he is unable to extend his elbow joint. Which of the following tendons is most likely to have been cut?
Triceps Pronator teres Brachioradialis Brachialis Biceps
Triceps
The triceps muscle extends the elbow joint. The other muscles listed all produce flexion of the elbow joint.
You excitedly embark on your first laparoscopic cholecystectomy and during the operation the anatomy of Calots triangle is more hostile than anticipated. Whilst trying to apply a haemostatic clip you avulse the cystic artery. This is followed by brisk haemorrhage. From which source is this most likely to originate ?
Right hepatic artery Portal vein Gastroduodenal artery Liver bed Common hepatic artery
Right hepatic artery
The cystic artery is a branch of the right hepatic artery. There are recognised variations in the anatomy of the blood supply to the gallbladder. However, the commonest situation is for the cystic artery to branch from the right hepatic artery
A 43 year old man suffers a pelvic fracture which is complicated by an injury to the junction of the membranous urethra to the bulbar urethra. In which of the following directions is the extravasated urine most likely to pass?
Posteriorly into extra peritoneal tissues Laterally into the buttocks Into the abdomen Anteriorly into the connective tissues surrounding the scrotum None of the above
Anteriorly into the connective tissues surrounding the scrotum
When urethral rupture occurs as in this case the urine will tend to pass anteriorly because the fascial condensations will prevent lateral and posterior passage of the urine.
Which of the following does not pass through the superior orbital fissure?
Oculomotor nerve Abducens nerve Ophthalmic artery Ophthalmic division of the trigeminal nerve Ophthalmic veins
Ophthalmic artery
The ophthalmic artery, a branch of the internal carotid enters the orbit with the optic nerve in the canal.
Which nerve supplies the 1st web space of the foot?
Popliteal nerve Superficial peroneal nerve Deep peroneal nerve Tibial nerve Saphenous nerve
Deep peroneal nerve
The first web space is innervated by the deep peroneal nerve
During the course of a radical gastrectomy the surgeons detach the omentum and ligate the right gastro-epiploic artery. From which vessel does it originate?
Superior mesenteric artery Inferior mesenteric artery Coeliac axis Common hepatic artery Gastroduodenal artery
Gastroduodenal artery
The gastroduodenal artery arises at the superior part of the duodenum and descends behind it to terminate at its lower border. It terminates by dividing into the right gastro-epiploic artery and the superior pancreaticoduodenal artery. The right gastro-opiploic artery passes to the left and passes between the layers of the greater omentum to anastomose with the left gastro-epiploic artery.
Which of the following is not an intrinsic muscle of the hand?
Opponens pollicis Palmaris longus Flexor pollicis brevis Flexor digiti minimi brevis Opponens digiti minimi
Palmaris longus
Palmaris longus originates in the forearm.
A man with lung cancer and bone metastasis in the thoracic spinal vertebral bodies, sustains a pathological fracture at the level of T4. The fracture is unstable and the spinal cord is severely compressed at this level. Which of the findings below will not be present 6 weeks after injury?
Extensor plantar reflexes Spasticity of the lower limbs Diminished patellar tendon reflex Urinary incontinence Sensory ataxia
Diminished patellar tendon reflex
A thoracic cord lesion causes spastic paraperesis, hyperrflexia and extensor plantar responses (UMN lesion), incontinence, sensory loss below the lesion and ‘sensory’ ataxia.These features typically manifest several weeks later, once spinal shock (in which areflexia predominates) has resolved.
Through which of the following foramina does the genital branch of the genitofemoral nerve exit the abdominal cavity?
Superficial inguinal ring Sciatic notch Obturator foramen Femoral canal Deep inguinal ring
Deep inguinal ring
The genitofemoral nerve divides into two branches as it approaches the inguinal ligament. The genital branch passes anterior to the external iliac artery through the deep inguinal ring into the inguinal canal. It communicates with the ilioinguinal nerve in the inguinal canal (though this is seldom of clinical significance)
A 28 year old man lacerates the posterolateral aspect of his wrist with a knife in an attempted suicide. On arrival in the emergency department the wound is inspected and found to be located over the lateral aspect of the extensor retinaculum (which is intact). Which of the following structures is at greatest risk of injury?
Superficial branch of the radial nerve Radial artery Dorsal branch of the ulnar nerve Tendon of extensor carpi radialis brevis Tendon of extensor digiti minimi
Superficial branch of the radial nerve
The superficial branch of the radial nerve passes superior to the extensor retinaculum in the position of this laceration and is at greatest risk of injury. The dorsal branch of the ulnar nerve and artery also pass superior to the extensor retinaculum but are located medially.
A 43 year old man is reviewed in the clinic following a cardiac operation. A chest x-ray is performed and a circular radio-opaque structure is noted medial aspect of the 4th intercostal space on the left. Which of the following procedures is the patient most likely to have undergone?
Aortic valve replacement with metallic valve Tricuspid valve replacement with metallic valve Tricuspid valve replacement with porcine valve Pulmonary valve replacement with porcine valve Mitral valve replacement with metallic valve
Mitral valve replacement with metallic valve
A 63 year old lady is diagnosed as having an endometrial carcinoma arising from the uterine body. To which nodal region will the tumour initially metastasise?
Para aortic nodes Iliac lymph nodes Inguinal nodes Pre sacral nodes Mesorectal lymph nodes
Iliac lymph nodes
Tumours of the uterine body will tend to spread to the iliac nodes initially. Tumour expansion crossing different nodal margins this is of considerable clinical significance, if nodal clearance is performed during a Wertheims type hysterectomy.
Transection of the radial nerve at the level of the axilla will result in all of the following except:
Loss of elbow extension. Loss of extension of the interphalangeal joints. Loss of metacarpophalangeal extension. Loss of triceps reflex. Loss of sensation overlying the first dorsal interosseous.
Loss of sensation overlying the first dorsal interosseous.
These may still extend by virtue of retained lumbrical muscle function
Which of the following structures is not located in the superficial perineal space in females?
Posterior labial arteries Pudendal nerve Superficial transverse perineal muscle Greater vestibular glands None of the above
Pudendal nerve
The pudendal nerve is located in the deep perineal space and then branches to innervate more superficial structures.
Which of the following is not a branch of the hepatic artery?
Pancreatic artery Cystic artery Right gastric artery Right hepatic artery Gastroduodenal artery
Pancreatic artery
The pancreatic artery is a branch of the splenic artery.
Which of the following structures does not pass close to the piriformis muscle in the greater sciatic foramen?
Sciatic nerve Posterior cutaneous nerve of the thigh Inferior gluteal artery Obturator nerve None of the above
Obturator nerve
The obturator nerve does not pass through the greater sciatic foramen.
A 56 year old man is undergoing a right nephrectomy. The surgeons divide the renal artery. At what level does this usually branch off the abdominal aorta?
T9 L2 L3 T10 L4
L2
The renal arteries usually branch off the aorta on a level with L2.
A 23 year old man is shot in the chest during a robbery. The left lung is lacerated and is bleeding. An emergency thoracotomy is performed. The surgeons place a clamp over the hilum of the left lung. Which of the following structures lies most anteriorly at this level?
Vagus nerve Oesophagus Descending aorta Phrenic nerve Azygos vein
Phrenic nerve
The phrenic nerve lies anteriorly at this point. The vagus passes anteriorly and then arches backwards immediately superior to the root of the left bronchus, giving off the recurrent laryngeal nerve as it does so.
A 22 year old man presents with appendicitis. At operation the appendix is retrocaecal and difficult to access. Division of which of the following anatomical structures should be undertaken?
Ileocolic artery Mesentery of the caecum Gonadal vessels Lateral peritoneal attachments of the caecum Right colic artery
Lateral peritoneal attachments of the caecum
The commonest appendiceal location is retrocaecal. Those struggling to find it at operation should trace the tenia to the caecal pole where the appendix is located. If it cannot be mobilised easily then division of the lateral caecal peritoneal attachments (as for a right hemicolectomy) will allow caecal mobilisation and facilitate the procedure
