Question 1 of 560 Which of the following ... - 1 File Download

Question 1 of 560

Which of the following structures is not transmitted by the jugular foramen?

Hypoglossal nerve

Accessory nerve

Internal jugular vein

Inferior petrosal sinus

Vagus nerve

Submit answer Question 2 of 560

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?

Ligamentum flavum

Denticulate ligament

Dural sheath

Pia Mater

Supraspinous ligament


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


A patient undergoes a femoral hernia repair and at operation the surgeon decides to enter the abdominal cavity to resect small bowel. She makes a transverse incision two thirds of the way between umbilicus and the symphysis pubis. Which of the structures listed below will not be divided?

Rectus abdominis

External oblique aponeurosis

Peritoneum

Fascia transversalis

Posterior lamina of the rectus sheath


What is the lymphatic drainage of the ovaries?

Internal iliac nodes

Common iliac nodes

Para-aortic nodes

Para uterine nodes

Inguinal nodes

Submit answer Question 6-8 of 560

Theme: Axillary anatomy

A. Medial pectoral nerve

B. Thoracodorsal nerve

C. Lateral pectoral nerve

D. Intercostobrachial nerve

E. Medial cord of the brachial plexus

F. Long thoracic nerve

G. Axillary nerve

H. Accessory nerve Please identify the structure that is most likely to be affected in the scenarios described below. Each structure may be used once, more than once or not at all.

6. A 44 year old lady has undergone a mastectomy and axillary node clearance. Post

operatively, she notices a patch of anaesthesia of her axillary skin when she applies an

underarm deodorant.

7. A 44 year old lady has undergone a mastectomy and axillary node clearance to treat breast

cancer. Post operatively, it is noted that she has winging of the scapula.

8. A 44 year old lady who works as an interior decorator has undergone a mastectomy and

axillary node clearance to treat breast cancer. Post operatively, she comments that her arm

easily becomes fatigued when she is painting walls.


A 35 year old farm labourer injures the posterior aspect of his hand with a mechanical scythe. He severs some of his extensor tendons in this injury. How many tunnels lie in the extensor retinaculum that transmit the tendons of the extensor muscles?

One

Three

Four

Five

Six


A 23 year old man undergoes an orchidectomy. The right testicular vein is ligated; into which structure does it drain?

Right renal vein

Inferior vena cava

Common iliac vein

Internal iliac vein

External iliac vein


A 44 year old lady is undergoing an abdominal hysterectomy and the ureter is identified during the ligation of the uterine artery. At which site does it insert into the bladder?

Posterior

Apex

Anterior

Base

Superior aspect of the lateral side


What is the correct embryological origin of the stapes?

First pharyngeal arch

Second pharyngeal arch

Third pharyngeal arch

Fourth pharyngeal arch

Fifth pharyngeal arch


A 20 year old lady presents with pain on the medial aspect of her thigh. Investigations show a large ovarian cyst. Compression of which of the nerves listed below is the most likely underlying cause?

Sciatic

Genitofemoral

Obturator

Ilioinguinal

Femoral cutaneous


A 73 year old man presents with a tumour at the central aspect of the posterior third of the tongue. To which of the following lymph node groups is it most likely to metastasise?

Submental

Submandibular

Ipsilateral deep cervical nodes

Contralateral deep cervical nodes

Bilateral deep cervical nodes


A 6 month old child is brought to the surgical clinic because of non descended testes. What is the main structure that determines the descent path of the testicle?

Processus vaginalis

Cremaster

Mesorchium

Inguinal canal

Gubernaculum


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


What is the most important structure involved in supporting the uterus?

Round ligament

Broad ligament

Uterosacral ligaments

Cardinal ligaments

Central perineal tendon


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?

Second pharyngeal pouch

Third pharyngeal pouch

Fourth pharyngeal pouch

First pharyngeal pouch

None of the above


A 23 year old man falls and slips at a nightclub. A shard of glass penetrates the skin at the level of the medial epicondyle, which of the following sequelae is least likely to occur?

Atrophy of the first dorsal interosseous muscle

Difficulty in abduction of the the 2nd, 3rd, 4th and 5th fingers

Claw like appearance of the hand

Loss of sensation on the anterior aspect of the 5th finger

Partial denervation of flexor digitorum profundus


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?

Facial nerve

External carotid artery

Occipital artery

Maxillary artery

Retromandibular vein


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?

Ulnar deviation of the wrist

Complete loss of wrist flexion

Loss of pronation

Loss of flexion at the thumb joint

Inability to oppose the thumb


A 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?

Recurrent laryngeal nerve

Sympathetic chain

Hypoglossal nerve

Phrenic nerve

Lingual nerve


Which of the structures listed below articulates with the head of the radius superiorly?

Capitulum

Trochlea

Lateral epicondyle

Ulna

Medial epicondyle


Which of the following fascial structures encases the apex of the lungs?

Waldeyers fascia

Sibsons fascia

Pretracheal fascia

Clavipectoral fascia

None of the above


Which of the structures listed below inserts into the site labelled in the image.

© Image provided by the University of Sheffield

Psoas minor

Psoas major

Sartorius

Obturator externus

Gemellus


As regards the internal jugular vein, which of the following statements is untrue?

It lies within the carotid sheath

It is the continuation of the sigmoid sinus

The terminal part of the thoracic duct crosses anterior to it to insert into the right

subclavian vein

The hypoglossal nerve is closely related to it as it passes near the atlas

The vagus nerve is closely related to it within the carotid sheath


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?

Bulbar urethra

Membranous urethra

Internal sphincter

Prostatic urethra

Bladder neck


Which of the following anatomical structures lies within the spiral groove of the humerus?

Median nerve

Radial nerve

Tendon of triceps

Musculocutaneous nerve

Axillary nerve


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

From the proximal end

From the distal end


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?

Inferior epigastric artery

Conjoint tendon

Rectus abdominis muscle


Transversalis fascia


Which of the following cranial venous sinuses is unpaired?

Transverse sinus

Superior sagittal sinus

Cavernous sinus

Sigmoid sinus

Inferior petrosal sinus


Which of the following laryngeal tumours will not typically metastasise to the cervical lymph nodes?

Glottic

Supraglottic

Subglottic

Transglottic

Aryepiglottic fold


Which of the following forms the medial wall of the femoral canal?

Pectineal ligament

Adductor longus

Sartorius

Lacunar ligament

Inguinal ligament


A 67 year old man is undergoing a transurethral resection of a bladder tumour using diathermy. Suddenly during the procedure the patient's thigh begins to twitch. Stimulation of which of the following nerves is the most likely cause?

Femoral

Pudendal

Sciatic

Obturator

Gluteal


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?

Right lower lobe

Left main bronchus

Right upper lobe

Left lower lobe

None of the above


A patient presents with superior vena caval obstruction. How many collateral circulations exist as alternative pathways of venous return?

None

One

Two

Three

Four


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


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


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?

Cystic artery

Hepatic artery

Portal vein

Left gastric artery

None of the above


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

In their lower half

In the middle

At their origin from the hyoid

At the point of their insertion


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?

Vitello-intestinal duct

Uranchus

Foregut

Hindgut

Midgut


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?

Hypoglossal nerve

Lingual nerve

Inferior alveolar nerve

Facial nerve

Lesser petrosal nerve


You decide to take an arterial blood gas from the femoral artery. Where should the needle be inserted to gain the sample?

Mid point of the inguinal ligament

Mid inguinal point

2cm inferomedially to the pubic tubercle

2cm superomedially to the pubic tubercle

3cm inferolaterally to the deep inguinal ring


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 accessory nerve

Damage to the cervical plexus

Damage to the glossopharyngeal nerve

Damage to the hypoglossal nerve

Damage to the vagus


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?



Conjoint tendon

Rectus abdominis

Inferior epigastric artery


Which muscle initiates abduction of the shoulder?

Infraspinatus

Latissimus dorsi

Supraspinatus

Deltoid

Teres major


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?

Popliteal artery

Popliteal vein

Common peroneal nerve

Tibial nerve

Small saphenous vein


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?

Inferior mesenteric artery

Superior mesenteric artery

Coeliac axis

Testicular artery

None of the above


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?

Glossopharyngeal

Greater petrosal

Olfactory

Trigeminal

Chorda tympani


The first root of the brachial plexus commonly arises at which of the following levels?

C6

C5

C3

C2

C8


What is the anatomical level of the transpyloric plane?

T11

T12

L1

L4

T10

Question 52 of 560

A 35 year old man falls and sustains a fracture to the medial third of his clavicle. Which vessel is at greatest risk of injury?

Subclavian vein

Subclavian artery


Internal carotid artery

Vertebral artery


Where are the greatest proportion of musculi pectinati found?

Right ventricle

Left ventricle

Right atrium

Pulmonary valve

Aortic valve


Which of the following structures separates the subclavian artery and vein?

Digastric muscle

Prevertebral fascia

Anterior scalene muscle

Middle scalene muscle

Omohyoid


A 33 year old man is stabbed in the right chest and undergoes a thoracotomy. The right lung is mobilised and the pleural reflection at the lung hilum is opened. Which of the structures listed below does not lie within this region?

Pulmonary artery

Azygos vein

Pulmonary vein

Bronchus

None of the above


A 56 year old man requires long term parenteral nutrition and the decision is made to insert a PICC line for long term venous access. This is inserted into the basilic vein at the region of the elbow. As

the catheter is advanced, into which venous structure is the tip of the catheter most likely to pass from the basilic vein?

Subclavian vein

Axillary vein

Posterior circumflex humeral vein

Cephalic vein

Superior vena cava


An individual is noted to have a left sided superior vena cava. By which pathway is blood from this system most likely to enter the heart?

Via the coronary sinus

Via the azygos venous system and into the superior vena cava

Via anomalies in the pumonary vascular bed

Via the left atrium and persistent foramen ovale

Directly into the roof of the right atrium


Theme: Nerve injury

A. Ulnar nerve

B. Musculocutaneous nerve

C. Radial nerve

D. Median nerve

E. Axillary nerve

F. Intercostobrachial nerve What is the most likely nerve injury for the scenario given? Each option may be used once, more than once or not at all.

58. 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.

59. 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.

60. 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.


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?

Lesser omentum

Greater omentum

Falciform ligament

Median arcuate ligament

Gastrosplenic ligament


A 76 year old man complains of symptoms of claudication. 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?

Posterior tibial artery

Anterior tibial artery

Peroneal artery

Popliteal artery

None of the above


A 67 year old man is due to undergo a revisional total hip replacement using a posterior approach. After dividing gluteus maximus in the line of its fibres there is brisk arterial bleeding. Which of the following vessels is likely to be responsible?

Profunda femoris artery

External iliac artery

Internal iliac artery

Obturator artery

Inferior gluteal artery


A 17 year old lady presents with right iliac fossa pain and diagnosed as having acute appendicitis. You take her to theatre to perform a laparoscopic appendicectomy. During the procedure the scrub nurse distracts you and you inadvertently avulse the appendicular artery. The ensuing haemorrhage is likely to be supplied directly from which vessel?



Ileo-colic artery


None of the above


A 63 year old man who smokes heavily presents with dyspepsia. He is tested and found to be positive for helicobacter pylori infection. One evening he has an episode of haematemesis and collapses. What is the most likely vessel to be responsible?

Portal vein

Short gastric arteries


Gastroduodenal artery

None of the above


Which of the following nerves is responsible for the cremasteric reflex?

Lateral femoral cutaneous nerve

Femoral nerve

Obturator nerve

Genitofemoral nerve

None of the above


Which of the structures listed below are not located within the mediastinum?

Thymus

Heart

Great vessels

Arch of azygos vein

Vertebral bodies


A 22 year old man is stabbed in the chest at the level of the junction between the sternum and manubrium. Which structure is at greatest risk?

Left atrium

Oesophagus

Thyroid gland

Inferior vena cava

Aortic arch


Which of these nerves passes through the greater and lesser sciatic foramina?

Pudendal nerve

Sciatic nerve

Superior gluteal nerve

Inferior gluteal nerve

Posterior cutaneous nerve of the thigh


A cervical rib is due to which of the following?

Hyperplasia of the annulus fibrosus

Proliferation of the nucleus pulposus

Fusion of the transverse processes of the 6th and 7th cervical vertebrae

An accessory cervical vertebra

Elongation of the transverse processes of the 7th cervical vertebra


Which of the structures listed below is not a content of the carotid sheath?



Vagus nerve


Common carotid artery


A 22 year old man is undergoing a wedge excision of his great toenail. As the surgeon passes a needle into the area to administer local anaesthetic, the patient notices a sharp pain. By which pathway will this sensation be conveyed to the central nervous system?

Anterior corticospinal tract

Posterior spinocerebellar tract

Cuneate fasciculus

Vestibulospinal tract

Spinothalamic tract


A 73 year old lady is admitted with brisk rectal bleeding. Despite attempts at resuscitation the bleeding proceeds to cause haemodynamic compromise. An upper GI endoscopy is normal. A mesenteric angiogram is performed and a contrast blush is seen in the region of the sigmoid colon. The radiologist decides to embolise the vessel supplying this area. At what spinal level does it leave the aorta?

L2

L1

L4

L3

T10


A 23 year old lady with troublesome axillary hyperhidrosis is undergoing a thorascopic sympathectomy to treat the condition. Which of the following structures will need to be divided to access the sympathetic trunk?

Intercostal vein

Intercostal artery

Parietal pleura

Visceral pleura

None of the above


In which space is a lumbar puncture performed?

Subdural space

Epidural space

Subarachnoid space

Extradural space

Intraventricular space


A 21 year old man is stabbed in the antecubital fossa. A decision is made to surgically explore the wound. At operation the surgeon dissects down onto the brachial artery. A nerve is identified medially, which nerve is it likely to be?

Radial

Recurrent branch of median

Anterior interosseous

Ulnar

Median


A 65 year old man with long standing atrial fibrillation develops an embolus to the lower leg. The decision is made to perform an embolectomy, utilising a trans popliteal approach. After incising the deep fascia, which of the following structures will the surgeons encounter first on exploring the central region of the popliteal fossa?

Popliteal vein


Popliteal artery

Tibial nerve

None of the above


A 43 year old man is undergoing a right hemicolectomy and the ileo-colic artery is ligated. From which of the following vessels is is derived?



Coeliac axis

Aorta

None of the above


A 53 year old man is undergoing a distal pancreatectomy for trauma. Which of the following vessels is responsible for the arterial supply to the tail of the pancreas?

Splenic artery

Pancreaticoduodenal artery

Gastric artery

Hepatic artery



A 43 year old lady presents with varicose veins and undergoes a saphenofemoral disconnection, long saphenous vein stripping to the ankle and isolated hook phlebectomies. Post operatively she notices an area of numbness superior to her ankle. What is the most likely cause for this?

Sural nerve injury

Femoral nerve injury

Saphenous nerve injury

Common peroneal nerve injury

Superficial peroneal nerve injury


Which of the following muscles does not attach to the radius?

Pronator quadratus

Biceps

Brachioradialis

Supinator

Brachialis


A 25 year old man is stabbed in the upper arm. The brachial artery is lacerated at the level of the proximal humerus, and is being repaired. A nerve lying immediately lateral to the brachial artery is also lacerated. Which of the following is the nerve most likely to be?

Ulnar nerve

Median nerve

Radial nerve

Intercostobrachial nerve

Axillary nerve


What is the course of the median nerve relative to the brachial artery in the upper arm?

Medial to anterior to lateral

Lateral to posterior to medial

Medial to posterior to lateral

Medial to anterior to medial

Lateral to anterior to medial


Which of the following is not a content of the cavernous sinus?

Oculomotor nerve


Opthalmic nerve

Abducens nerve

Optic nerve


Surgical occlusion of which of these structures, will result in the greatest reduction in hepatic blood flow?

Portal vein

Common hepatic artery

Right hepatic artery

Coeliac axis

Left hepatic artery


A 43 year old man is due to undergo an excision of the sub mandibular gland. Which of the following incisions is the most appropriate for this procedure?

A transversely orientated incision 4cm below the mandible

A transversely orientated incision immediately inferior to the mandible

A vertical incision 3 cm anterior to the angle of the mandible and extending inferiorly

A transversely orientated incision 2cm above the mandible

A transversely orientated incision 12cm below the mandible


A 5 year old boy presents with recurrent headaches. As part of his assessment he undergoes an MRI scan of his brain. This demonstrates enlargement of the lateral and third ventricles. Where is the most likely site of obstruction?

Foramen of Luschka

Foramen of Magendie

Foramen of Munro

Aqueduct of Sylvius

None of the above


A 23 year old man presents with appendicitis. A decision is made to perform an appendicectomy. The operation commences with a 5cm incision centered on McBurneys point. Which of the following structures will be encountered first during the dissection?


Internal oblique muscle


Rectus sheath

Peritoneum


A 23 year old man is undergoing an inguinal hernia repair. The surgeons mobilise the spermatic cord and place it in a hernia ring. A small slender nerve is identified superior to the cord. Which nerve is it most likely to be?

Iliohypogastric nerve

Pudendal nerve

Femoral branch of the genitofemoral nerve

Ilioinguinal nerve

Obturator nerve


A 34 year old man undergoes excision of a sarcoma from the right buttock. During the procedure the sciatic nerve is sacrificed. Which of the following will not occur as a result of this process?

Loss of extension at the knee joint

Foot drop

Inability to extend extensor hallucis longus

Loss of sensation to the posterior aspect of the thigh

Loss of sensation to the posterior aspect of the lower leg


Where does the spinal cord terminate in neonates?

L1

L2

L3

L4

L5


A 45 year old man is undergoing a low anterior resection for a carcinoma of the rectum. Which of the following fascial structures will need to be divided to mobilise the mesorectum from the sacrum and coccyx?

Denonvilliers fascia

Colles fascia

Sibsons fascia

Waldeyers fascia

None of the above


What is the nerve supply to the muscle indicated by an X on the prosection below.

© Image provided by the University of Sheffield

CN XI

CN IX

Median pectoral nerve

Lateral pectoral nerve

Suprascapular nerve


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


A 73 year old lady is admitted with acute mesenteric ischaemia. A CT angiogram is performed and a stenotic lesion is noted at the origin of the superior mesenteric artery. At which of the following levels does this branch from the aorta?

L1

L2

L3

L4

L5


The following statements relating to the musculocutaneous nerve are true except?

It arises from the lateral cord of the brachial plexus

It provides cutaneous innervation to the lateral side of the forearm

If damaged, then extension of the elbow joint will be impaired

It supplies the biceps muscle

It runs beneath biceps


Which of the following structures does not pass through the foramen ovale?

Lesser petrosal nerve

Accessory meningeal artery

Maxillary nerve

Emissary veins

Otic ganglion


Which of the cranial nerves listed below is least likely to carry parasympathetic fibres?

III

VII

IX

X

II


A 72 year old man is undergoing an open abdominal aortic aneurysm repair. The aneurysm is located in a juxtarenal location and surgical access to the neck of aneurysm is difficult. Which of the following structures may be divided to improve access?

Cisterna chyli

Transverse colon

Left renal vein


Coeliac axis


An occlusion of the anterior cerebral artery may compromise the blood supply to the following structures except:

Medial inferior surface of the frontal lobe

Corpus callosum

Medial surface of the frontal lobe

Olfactory bulb

Brocas area


Parasympathetic fibres innervating the parotid gland originate from which of the following?

Submandibular ganglion

Otic ganglion

Ciliary ganglion

Pterygopalatine ganglion

None of the above


Following an oesophagogastrectomy the surgeons will anastomose the oesophageal remnant to the stomach, which of the following is not part of the layers that comprise the oesophageal wall?

Serosa

Adventitia

Muscularis propria

Submucosa

Mucosa


Which of the following structures suspends the spinal cord in the dural sheath?

Filum terminale

Conus medullaris

Ligamentum flavum

Denticulate ligaments

Anterior longitudinal ligament


Where is the 'safe triangle' for chest drain insertion located?

4th intercostal space, mid axillary line

5th intercostal space, mid axillary line

4th intercostal space, mid scapular line

5th intercostal space, mid scapular line

4th intercostal space, mid clavicular line


Your consultant decides to perform an open inguinal hernia repair under local anaesthesia. Which of the following dermatomal levels will require blockade?

T10

T12

T11

S1

S2


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

None of the above


A 45 year old lady develops severe back pain and on examination is found to have clinical evidence of an L5/ S1 radiculopathy. Her symptoms deteriorate and eventually a laminectomy is performed. During a posterior surgical approach the surgeons encounter a tough ligamentous structure lying anterior to the spinous processes. This structure is most likely to be the

Transverse spinal ligament

Supraspinal ligament

Anterior longitudinal ligament

Ligamentum flavum

Posterior longitudinal ligament


Which of the following does not pass through the superior orbital fissure?

Lacrimal nerve

Abducens nerve

Opthalmic artery

Trochlear nerve

Superior opthalmic vein


An 18 year old man undergoes a tonsillectomy for attacks of recurrent acute tonsillitis. Whilst in recovery he develops a post operative haemorrhage. Which of the following vessels is the most likely culprit?

Facial vein

External palatine vein



None of the above


A patient is found to have an ischaemic left colon. Which artery arising from the aorta at around the level of L3 is most likely to account for this situation?



Superior rectal artery

Ileocolic artery

Middle colic artery


At which level does the aorta perforate the diaphragm?

T10

T9

T8

T11

T12


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


At which level is the hilum of the left kidney located?

L1

L2

T12

T11

L3


During a radical neck dissection, division of which of the following fascial layers will expose the ansa cervicalis?

Pretracheal fascia

Carotid sheath

Prevertebral fascia

Investing layer of fascia

Sibsons fascia


A 73 year old lady presents with symptoms of faecal incontinence. On examination she has weak anal sphincter muscles. What are the main nerve root values of the nerves supplying the external anal sphincter?

S2,3

L5, S1

S4,5

S5

S2,3,4


A 22 year old falls over and lands on a shard of glass. It penetrates the palmar aspect of his hand, immediately lateral to the pisiform bone. Which of the following structures is most likely to be injured?

Palmar cutaneous branch of the median nerve

Lateral tendons of flexor digitorum superficialis

Ulnar artery

Flexor carpi radialis tendons

Lateral tendons of flexor digitorum profundus


A 72 year old man has a fall. He is found to have a fractured neck of femur and goes on to have a left hip hemiarthroplasty. Two months post operatively he is found to have an odd gait. When standing on his left leg his pelvis dips on the right side. There is no foot drop. What is the cause?

Sciatic nerve damage

L5 radiculopathy

Inferior gluteal nerve damage

Previous poliomyelitis

Superior gluteal nerve damage


Which of the following structures lies posterior to the femoral nerve in the femoral triangle?

Adductor longus

Pectineus

Psoas major

Iliacus

None of the above


You are assisting in an open right adrenalectomy for a large adrenal adenoma. The consultant is distracted and you helpfully pull the adrenal into the wound to improve the view. Unfortunately this is followed by brisk bleeding. The vessel responsible for this is most likely to be:

Portal vein

Phrenic vein

Right renal vein

Superior mesenteric vein

Inferior vena cava


A 28 year old lady requires an episiotomy for a ventouse vaginal delivery. Which of the nerves listed below will usually be anaesthetised to allow the episiotomy?

Femoral

Ilioinguinal

Pudendal

Genitofemoral

Sacral plexus


A motorcyclist is involved in a road traffic accident. He suffers a complex humeral shaft fracture which is plated. Post operatively he complains of an inability to extend his fingers. Which of the following structures is most likely to have been injured?

Ulnar nerve

Radial nerve

Median nerve

Axillary nerve

None of the above


An enthusiastic surgical registrar undertakes his first solo splenectomy. The operation is far more difficult than anticipated and the registrar leaves a tube drain to the splenic bed at the end of the procedure. Over the following 24 hours approximately 500ml of clear fluid has entered the drain. Biochemical testing of the fluid is most likely to reveal:

Elevated creatinine

Elevated triglycerides

Elevated glucagon

Elevated amylase

None of the above


A 48 year old lady is undergoing an axillary node clearance for breast cancer. Which of the structures listed below are most likely to be encountered during the axillary dissection?

Cords of the brachial plexus

Thoracodorsal trunk

Internal mammary artery

Thoracoacromial artery

None of the above


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


A 56 year old lady is referred to the colorectal clinic with symptoms of pruritus ani. On examination a polypoidal mass is identified inferior to the dentate line. A biopsy confirms squamous cell carcinoma. To which of the following lymph node groups will the lesion potentially metastasise?

Internal iliac

External iliac

Mesorectal

Inguinal

None of the above


A 20 year old man is hit with a hammer on the right side of the head. He dies on arrival in the emergency department. Which of these features is most likely to be found at post mortem?

Hydrocephalus

Supra tentorial herniation

Laceration of the middle meningeal artery

Sub dural haematoma

Posterior fossa haematoma


Which of the following ligaments contains the artery supplying the head of femur in children?

Transverse ligament

Ligamentum teres

Iliofemoral ligament

Ischiofemoral ligament

Pubofemoral ligament


A 72 year old man develops a hydrocele which is being surgically managed. As part of the procedure the surgeons divide the tunica vaginalis. From which of the following is this structure derived?

Peritoneum


Internal oblique aponeurosis


Rectus sheath


A 43 year old lady is donating her left kidney to her sister and the surgeons are harvesting the left kidney. Which of the following structures will lie most anteriorly at the hilum of the left kidney?

Left renal artery

Left renal vein

Left ureter

Left ovarian vein

Left ovarian artery


What is the sensory nerve supply to the angle of the jaw?

Maxillary branch of the trigeminal nerve

Mandibular branch of the trigeminal nerve

C3-C4

Greater auricular nerve (C2-C3)

Buccal branch of the facial nerve


A 63 year old man is undergoing a coronary artery bypass procedure. During the median sternotomy which structure would routinely require division?

Parietal pleura

Interclavicular ligament

Internal mammary artery

Brachiocephalic vein

Left vagus nerve


Which of the following structures separates the subclavian artery from the subclavian vein?

Scalenus anterior

Scalenus medius

Sternocleidomastoid

Pectoralis major

Pectoralis minor


Which of the following structures separates the subclavian artery from the subclavian vein?

Scalenus anterior

Scalenus medius

Sternocleidomastoid

Pectoralis major

Pectoralis minor


A 56 year old lady is due to undergo a left hemicolectomy for carcinoma of the splenic flexure. The surgeons decide to perform a high ligation of the inferior mesenteric vein. Into which of the following does this structure usually drain?

Portal vein

Inferior vena cava

Left renal vein

Left iliac vein

Splenic vein


A man undergoes a high anterior resection for carcinoma of the upper rectum. Which of the following vessels will require ligation?



Coeliac axis

Perineal artery

Middle colic artery


A 43 year old lady is due to undergo an axillary node clearance as part of treatment for carcinoma of the breast. Which of the following fascial layers will be divided during the surgical approach to the axilla?

Sibsons fascia

Pre tracheal fascia

Waldayers fascia


None of the above


What are the boundaries of the 'safe triangle' for chest drain insertion?

Bounded by trapezius, latissimus dorsi, and laterally by the vertebral border of the scapula

Bounded by latissimus dorsi, pectoralis major, line superior to the nipple and apex at the

axilla

Bounded by latissimus dorsi, serratus anterior, line superior to the nipple and apex at the

axilla

Bounded by trapezius, deltoid, rhomboid major and teres minor

Bounded by trapezius, deltoid and latissimus dorsi


The vertebral artery traverses all of the following except?

Transverse process of C6

Transverse process of the axis

Vertebral canal

Foramen magnum

Intervertebral foramen


A 60 year old female attends the preoperative hernia clinic. She reports some visual difficulty. On examination she is noted to have a homonymous hemianopia. Where is the lesion most likely to be?

Frontal lobe

Pituitary gland

Parietal lobe

Optic chiasm

Optic tract


A 34 year old male is being examined in the pre-operative assessment clinic. A murmur is identified in the 4th intercostal space just next to the left side of the sternum. From where is it most likely to have originated?

Mitral valve

Aortic valve

Pulmonary valve

Right ventricular aneurysm

Tricuspid valve


During an Ivor Lewis Oesophagectomy for carcinoma of the lower third of the oesophagus which structure is divided to allow mobilisation of the oesophagus?

Vagus nerve

Azygos vein

Right inferior lobar bronchus

Phrenic nerve

Pericardiophrenic artery


Which of the following statements relating to quadratus lumborum is false?

Causes flexion of the thoracic spine

Causes the rib cage to be pulled down

Innervated by anterior primary rami of T12 and L1-3

Attached to the iliac crest

Inserts into the 12th rib


A 23 year old climber falls and fractures his humerus. The surgeons decide upon a posterior approach to the middle third of the bone. Which of the following nerves is at greatest risk in this approach?

Ulnar

Antebrachial

Musculocutaneous

Radial

Intercostobrachial


Theme: Nerve injury

A. Median nerve

B. Ulnar nerve

C. Radial nerve

D. Posterior interosseous nerve

E. Anterior interosseous nerve

F. Musculocutaneous nerve

G. Axillary nerve

H. Brachial Trunks C5-6

I. Brachial trunks C6-7

J. Brachial Trunks C8-T1

Please select the most likely lesion site for each scenario. Each option may be used once, more than once or not at all.

143. A 42 year old teacher is admitted with a fall. An x-ray confirms a fracture of the surgical

neck of the humerus. Which nerve is at risk?

144. A 32 year old window cleaner is admitted after falling off the roof. He reports that he had

slipped off the top of the roof and was able to cling onto the gutter for a few seconds. The

patient has Horner's syndrome.

145. A 32 year old rugby player is hit hard on the shoulder during a rough tackle. Clinically

his arm is hanging loose on the side. It is pronated and medially rotated.


A 68 year old man with critical limb ischaemia is undergoing a femoro-distal bypass graft. During mobilisation of the proximal part of the posterior tibial artery which of the following is at greatest risk of injury?

Tibial nerve

Sciatic nerve

Saphenous nerve


Medial superior genicular artery

Submit answer

Question 147 of 560

A 67 year old man is undergoing an angiogram for gastro intestinal bleeding. The radiologist advances the catheter into the coeliac axis. At what spinal level does this vessel typically arise from the aorta?

T10

L3

L4

T12

None of the above


Which muscle does not insert on the medial surface of the greater trochanter?

Gemelli

Obturator internus

Piriformis

Quadratus femoris

Obturator externus


During a radical gastrectomy for carcinoma of the stomach the surgeons remove the omentum. What is the main source of its blood supply?

Ileocolic artery


Gastroepiploic artery

Middle colic artery



A 38 year old lady is due to undergo a parathyroidectomy for hyperparathyroidism. At operation the inferior parathyroid gland is identified as being enlarged. A vessel is located adjacent to the gland laterally. This vessel is most likely to be the:




External jugular vein

None of the above


A 45 year old man has a long femoral line inserted to provide CVP measurements. The catheter passes from the common iliac vein into the inferior vena cava. At which of the following vertebral levels will this occur?

L5

L4

S1

L3

L2


Following a carotid endarterectomy a man notices that he has a weakness of his tongue. Damage to which of the following nerves is the most likely explanation for this process?

Hypoglossal

Accessory

Ansa cervicalis

Vagus

Cervical plexus


At which of the following levels does the inferior vena cava exit the abdominal cavity?

T6

T7

T10

T8

T12


Which of the following structures lies deepest in the popliteal fossa?

Popliteal artery

Popliteal vein

Tibial nerve


Popliteal lymph nodes


Which of the following nerves is responsible for innervation of the triceps muscle?

Radial

Ulnar

Axillary

Median

None of the above


Which of the positions listed below best describes the location of the coeliac autonomic plexus?

Anterolateral to the aorta

Posterolateral to the aorta

Anterolateral to the sympathetic chain

Anteromedial to the sympathetic chain

Posterior to L1


An intravenous drug user develops a false aneurysm and requires emergency surgery. The procedure is difficult and the femoral nerve is inadvertently transected. Which of the following muscles is least likely to be affected as a result?

Sartorius

Vastus medialis

Pectineus

Quadriceps femoris

Adductor magnus


What is the nerve root value of the external urethral sphincter?

S4

S1, S2, S3

S2, S3, S4

L3, L4, L5

L5, S1, S2


A 45 year old man is stabbed in the abdomen and the inferior vena cava is injured. How many functional valves does this vessel usually have?

0

1

3

2

4


Which of the following structures does not pass posteriorly to the medial malleolus?

Posterior tibial artery

Tibial nerve

Tibialis anterior tendon

Tendon of flexor digitorum longus

Tendon of flexor hallucis longus


Which of the following statements relating to the root of the neck is false?

The lung projects into the neck beyond the first rib and is constrained by Sibson's fascia

The subclavian artery arches over the first rib anterior to scalenus anterior

The roots and trunks of the Brachial plexus lie posterior to the subclavian artery on the

first rib

The roots and trunks of the Brachial plexus lie between scalenus anterior and scalenus

medius muscles

The thyrocervical trunk is a branch of the subclavian artery


A patient presents to the clinic following a surgical procedure. She complains that she is unable to shrug her shoulder. What is the most likely underlying nerve injury?

Accessory nerve

Cervical plexus

Ansa cervicalis

Long thoracic nerve

Axillary nerve


Which of the following are not generally supplied by the right coronary artery?

The sino atrial node

The circumflex artery

The atrioventricular node

Most of the right ventricle

The right atrium


A 44 year old man has a malignant melanoma and is undergoing a block dissection of the groin. The femoral triangle is being explored for intra operative bleeding. Which of the following forms the medial border of the femoral triangle?

Femoral artery

Biceps femoris

Adductor longus

Sartorius

Adductor magnus


The foramen marking the termination of the adductor canal is located in which of the following?

Adductor longus

Adductor magnus

Adductor brevis

Sartorius

Semimembranosus


Which of the following is the first vessel to branch from the external carotid artery?

Superior thyroid artery

Inferior thyroid artery

Lingual artery

Facial artery

Occipital artery


A motorcyclist is injured in a road traffic accident and is not wearing a helmet. He suffers a severe closed head injury and develops raised intracranial pressure. The first cranial nerve to be affected by this process is likely to be:

Oculomotor

Hypoglossal

Motor branch of the trigeminal

Abducens

Sensory branch of the trigeminal


A 32 year old man is undergoing a splenectomy. Division of which of the following will be necessary during the procedure?

Left crus of diaphragm

Short gastric vessels

Gerotas fascia

Splenic flexure of colon

Marginal artery


Which structure separates the cephalic vein and the brachial artery in the antecubital fossa?

Brachioradialis muscle

Biceps muscle

Origin of flexor digitorum profundus muscle

Pronator quadratus muscle

Origin of flexor digitorum superficialis muscle


A 24 year old motor cyclist is involved in a road traffic accident. He suffers a tibial fracture which is treated with an intra medullary nail. Post operatively he develops a compartment syndrome. Surgical decompression of the anterior compartment will relieve pressure on all of the following muscles except?

Peroneus brevis

Peroneus tertius

Extensor digitorum longus

Tibialis anterior

None of the above


A 43 year old lady underwent an attempted placement of a central line into the internal jugular vein. Unfortunately, the doctor damaged the carotid artery and this necessitated surgical exploration. As the surgeons incise the carotid sheath a nerve is identified lying between the internal jugular vein and the carotid artery. Which of the following is this nerve most likely to be?

Glossopharyngeal nerve

Hypoglossal nerve

Superior laryngeal nerve


Vagus


A patient has a chest drain insertion. There is fresh blood at the chest drain insertion area. Which vessel has been damaged?

Pericardiophrenic artery

Intercostal vein

Right ventricle

Vagus artery

Intercostal artery


Two teenagers are playing with an airgun when one accidentally shoots his friend in the abdomen. He is brought to the emergency department. On examination there is a bullet entry point immediately to the right of the rectus sheath at the level of the 1st lumbar vertebra. Which of the following structures is most likely to be injured by the bullet?

Head of pancreas

Right ureter

Right adrenal gland

Fundus of the gallbladder

Gastric antrum


Which of the following muscles inserts onto the lesser tuberostiy of the the humerus?

Subscapularis

Deltoid

Supraspinatus

Teres minor

Infraspinatus


Which of the following nerves is not contained within the posterior triangle of the neck?

Accessory nerve

Phrenic nerve

Greater auricular nerve

Ansa cervicalis

Lesser occiptal nerve


A 42 year old lady is reviewed in the outpatient clinic following a routine surgical procedure. She complains of diminished sensation at the dorso-lateral aspect of her foot. Which of the following nerves is most likely to be affected?

Sural

Superficial peroneal

Deep peroneal

Medial plantar

Lateral plantar


Which of the following anatomical planes separates the prostate from the rectum?

Sibsons fascia

Denonvilliers fascia

Levator ani muscle

Waldeyers fascia

None of the above


A 56 year old lady is undergoing an adrenalectomy for Conns syndrome. During the operation the surgeon damages the middle adrenal artery and haemorrhage ensues. From which of the following structures does this vessel originate?

Aorta

Renal artery

Splenic artery

Coeliac axis



A 73 year old lady suffers a fracture at the surgical neck of the humerus. The decision is made to operate. There are difficulties in reducing the fracture and a vessel lying posterior to the surgical neck is injured. Which of the following is this vessel most likely to be?

Axillary artery

Brachial artery


Transverse scapular artery

Posterior circumflex humeral artery


Which of the structures listed below lies posterior to the carotid sheath at the level of the 6th cervical vertebra?

Hypoglossal nerve

Vagus nerve

Cervical sympathetic chain

Ansa cervicalis



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


A 24 year old man falls and lands astride a manhole cover. He suffers from an injury to the anterior bulbar urethra. Where will the extravasated urine tend to collect?

Lesser pelvis

Connective tissue of the scrotum

Deep perineal space

Ischiorectal fossa

Posterior abdominal wall


A 73 year old man presents with symptoms of mesenteric ischaemia. As part of his diagnostic work up a diagnostic angiogram is performed .The radiologist is attempting to cannulate the coeliac axis from the aorta. At which of the following vertebral levels does this is usually originate?

T10

L2

L3

T8

T12


A 43 year old man is diagnosed as having a malignancy of the right adrenal gland. The decision is made to resect this via an open anterior approach. Which of the following will be most useful during the surgery?

Division of the coronary ligaments of the liver

Mobilisation of the colonic hepatic flexure

Division of the right renal vein

Division of the ligament of Trietz

Division of the right colic artery


A 45 year old man presents with a lipoma located posterior to the posterior border of the sternocleidomastoid muscle, approximately 4cm superior to the middle third of the clavicle. During surgical excision of the lesion troublesome bleeding is encountered. Which of the following is the most likely source?




Vertebral artery

Second part of the subclavian artery


Theme: Levels of spinal injury

A. C2

B. C3

C. C4

D. C5

E. C6

F. L1

G. L2

H. L3

I. L4

J. L5 Please select the most likely spinal level for the injury described. Each option may be used once, more than once or not at all.

186. A 62 year old male complains of back pain. He has had a recent fall. Walking causes pain

of the left lower leg. On examination he is noted to have reduced sensation over the knee.

187. A 42 year old woman is found to have a burst fracture of the C5 vertebral body. After a

few months where would the level of injury be?

188. A 56 year old man suddenly develops severe back pain. His pain has a radicular pattern.

On examination he is unable to extend his great toe.


The sciatic nerve lies deep to the following structures except:

Gluteus maximus

The femoral cutaneous nerve

Long head of biceps femoris

Gluteus medius

Branch of the inferior gluteal artery


Which of the following upper limb muscles is not innervated by the radial nerve?

Extensor carpi ulnaris

Abductor digiti minimi

Anconeus

Supinator

Brachioradialis


Which of the following forms the floor of the anatomical snuffbox?

Radial artery

Cephalic vein

Extensor pollicis brevis

Scaphoid bone

Cutaneous branch of the radial nerve


During a liver resection a surgeon performs a pringles manoeuvre to control bleeding. Which of the following structures will lie posterior to the epiploic foramen at this level?

Hepatic artery

Cystic duct

Greater omentum


Inferior vena cava


A 72 year old lady is suspected of having a femoral hernia. At which of the following sites is it most likely to be identifiable clinically?

Mid inguinal point

Above and medial to the pubic tubercle

Below and lateral to the pubic tubercle

Mid point of the inguinal ligament

3 cm superomedially to the superficial inguinal ring


Which muscle is responsible for causing flexion of the distal interphalangeal joint of the ring finger?

Flexor digitorum superficialis

Lumbricals

Palmar interossei

Flexor digitorum profundus

Flexor digiti minimi brevis


A 34 year old lady undergoes a thyroidectomy for Graves disease. Post operatively she develops a tense haematoma in the neck. In which of the following fascial planes will it be contained?

Gerotas fascia

Waldeyers fascia

Pretracheal fascia

Sibsons fascia



A 32 year old lady complains of carpal tunnel syndrome. The carpal tunnel is explored surgically. Which of the following structures will lie in closest proximity to the hamate bone within the carpal tunnel?

The tendon of abductor pollicis longus

The tendons of flexor digitorum profundus

The tendons of flexor carpi radialis longus

Median nerve

Radial artery


A 45 year old man sustains a significant head injury and a craniotomy is performed. The sigmoid sinus is bleeding profusely, into which of the following structures does it drain?


Straight sinus

Petrosal sinus

Inferior sagittal sinus



Which nerve supplies the interossei of the fourth finger?

Radial

Median

Superficial ulnar

Deep ulnar

Posterior interosseous


In which of the following cranial bones does the foramen spinosum lie?

Sphenoid bone

Frontal bone

Temporal bone

Occipital bone

Parietal bone


Which of the following is not considered a major branch of the descending thoracic aorta?

Bronchial artery

Mediastinal artery


Posterior intercostal artery

Oesophageal artery

Question 201 of 560

An 18 year old lady with troublesome hyperhidrosis of the hands and arms is due to undergo a sympathectomy to treat the condition. Which of the following should the surgeons divide to most effectively treat her condition?

Sympathetic ganglia at T1, T2 and T3

Sympathetic ganglia at T2 and T3

Sympathetic ganglia at T1 and T2

Stellate ganglion

Superior cervical ganglion


A 44 year old lady is recovering following a transphenoidal hypophysectomy. Unfortunately there is a post operative haemorrhage. Which of the following features is most likely to occur initially?

Cavernous sinus thrombosis

Abducens nerve palsy

Bi-temporal hemianopia

Inferior homonymous hemianopia

Central retinal vein occlusion


During a right hemicolectomy the caecum is mobilised. As the bowel is retracted medially a vessel is injured, posterior to the colon. Which of the following is the most likely vessel?

Right colic artery

Inferior vena cava

Aorta


Gonadal vessels


A 53 year old man with a carcinoma of the lower third of the oesophagus is undergoing an oesophagogastrectomy. As the surgeons mobilise the lower part of the oesophagus, where are they most likely to encounter the thoracic duct?

Anterior to the oesophagus

On the left side of the oesophagus

On the right side of the oesophagus

Immediately anterior to the azygos vein

Posterior to the oesophagus


Which of the following represents the root values of the sciatic nerve?

L4 to S3

L1 to L4

L3 to S1

S1 to S4

L5 to S1


The common peroneal nerve, or its branches, supply the following muscles except:

Peroneus longus

Tibialis anterior

Extensor hallucis longus

Flexor digitorum brevis

Extensor digitorum longus


An 83 year old lady presents with a femoral hernia and undergoes a femoral hernia repair. Which of the following forms the posterior wall of the femoral canal?

Pectineal ligament

Lacunar ligament

Inguinal ligament

Adductor longus

Sartorius


A 45 year man presents with hand weakness. He is given a piece of paper to hold between his thumb and index finger. When the paper is pulled, the patient has difficulty maintaining a grip. Grip pressure is maintained by flexing the thumb at the interphalangeal joint. What is the most likely nerve lesion?

Posterior interosseous nerve

Deep branch of ulnar nerve


Superficial branch of the ulnar nerve

Radial nerve


Which of the following statements relating to the right phrenic nerve is false?

It lies deep to the prevertebral layer of deep cervical fascia

Crosses posterior to the 2nd part of the subclavian artery

It runs on the anterior surface of the scalene muscle

On the right side it leaves the mediastinum via the vena cava hiatus at a level of T8

The right phrenic nerve passes over the right atrium


Which of the following cranial foramina pairings are incorrect?

Carotid canal and internal carotid artery.

Foramen ovale and mandibular nerve.

Optic canal and ophthalmic artery.

Optic canal and ophthalmic nerve.

Foramen rotundum and maxillary nerve.


A 22 year old man is involved in a fight and sustains a stab wound in his upper forearm. On examination there is a small, but deep laceration. There is an obvious loss of pincer movement involving the thumb and index finger with minimal loss of sensation. The most likely nerve injury is to the:

Ulnar nerve

Radial nerve


Axillary nerve

Median nerve


A 66 year old man is undergoing a left nephro-ureterectomy. The surgeons remove the ureter, which of the following is responsible for the blood supply to the proximal ureter?

Branches of the renal artery



Direct branches from the aorta

Common iliac artery


Which of the following structures does not pass behind the lateral malleolus?

Peroneus brevis tendon

Sural nerve

Short saphenous vein

Peroneus longus tendon

Tibialis anterior tendon


A 78 year old man presents with symptoms consistent with intermittent claudication. To assess the severity of his disease you decide to measure his ankle brachial pressure index. To do this you will identify the dorsalis pedis artery. Which of the following statements relating to this vessel is false?

It originates from the peroneal artery

It is crossed by the tendon of extensor hallucis brevis

Two veins are usually closely related to it

It passes under the inferior extensor retinaculum

The tendon of extensor hallucis longus lies medial to it.


Which of the following is not a content of the anterior triangle of the neck?

Vagus nerve

Submandibular gland

Phrenic nerve


Hypoglossal nerve


A 32 year old attends neurology clinic complaining of tingling in his hand. He has radial deviation of his wrist and there is mild clawing of his fingers, with the 4th and 5th digits being relatively spared. What is the most likely lesion?

Ulnar nerve damage at the wrist

Ulnar nerve damage at the elbow

Radial nerve damage at the elbow

Median nerve damage at the wrist

Median nerve damage at the elbow


A 22 year old man is undergoing an endotracheal intubation. Which of the following vertebral levels is consistent with the origin of the trachea?

C2

T1

C6

C4

C3


A young child undergoes a difficult craniotomy for fulminant mastoiditis and associated abscess. During the procedure the trigeminal nerve is severely damaged within Meckels cave. Which deficit is least likely to be present?

Anaesthesia over the ipsilateral anterior aspect of the scalp

Loss of the corneal reflex

Weakness of the ipsilateral masseter muscle

Anaesthesia of the anterior aspect of the lip

Anaesthesia over the entire ipsilateral side of the face


Theme: Nerve lesions

A. Iliohypogastric nerve

B. Ilioinguinal nerve

C. Lateral cutaneous nerve of the thigh

D. Femoral nerve

E. Saphenous nerve

F. Genitofemoral nerve Please select the most likely nerve implicated in the situation described. Each option may be used once, more than once or not at all.

219. A 42 year old woman complains of a burning pain of her anterior thigh which worsens on

walking. There is a positive tinel sign over the inguinal ligament.

220. A 29 year old woman has had a Pfannenstiel incision. She has pain over the inguinal

ligament which radiates to the lower abdomen. There is tenderness when the inguinal

canal is compressed.

221. A 22 year man is shot in the groin. On examination he has weak hip flexion, weak knee

extension, and impaired quadriceps tendon reflex, as well as sensory deficit in the

anteromedial aspect of the thigh.


Which of the following is not a branch of the external carotid artery?

Facial artery

Lingual artery


Mandibular artery

Maxillary artery


A 23 year old man is stabbed in the groin, several structures are injured and the adductor longus muscle has been lacerated. Which of the following nerves is responsible for the innervation of adductor longus?

Femoral nerve

Obturator nerve

Sciatic nerve


Ilioinguinal nerve


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


Which of the following muscles does not recieve any innervation from the sciatic nerve?

Semimembranosus

Quadriceps femoris

Biceps femoris

Semitendinosus

Adductor magnus


A 23 year old man is involved in a fight and is stabbed in his upper arm. The ulnar nerve is transected. Which of the following muscles will not demonstrate compromised function as a result?

Flexor carpi ulnaris

Medial half of flexor digitorum profundus

Palmaris brevis

Hypothenar muscles

Pronator teres


Which of the structures listed below overlies the cephalic vein?

Extensor retinaculum

Bicipital aponeurosis

Biceps muscle

Antebrachial fascia

None of the above


Which of the following pairings are incorrect?

Aortic bifurcation and L4

Transpyloric plane and L1

Termination of dural sac and L4

Oesophageal passage through diaphragm and T10

Transition between pharynx and oesophagus at C6

Question 229 of 560

A 22 year old man is involved in a fight. He sustains a laceration to the posterior aspect of his wrist. In the emergency department the wound is explored and the laceration is found to be transversely orientated and overlies the region of the extensor retinaculum, which is intact. Which of the following structures is least likely to be injured in this scenario?

Dorsal cutaneous branch of the ulnar nerve

Tendon of extensor indicis

Basilic vein

Superficial branch of the radial nerve

Cephalic vein


Which of the following is not a content of the porta hepatis?

Portal vein

Hepatic artery

Cystic duct

Lymph nodes

None of the above

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Question 231 of 560

Which of the following structures is not closely related to the carotid sheath?

Sternothyroid muscle

Sternohyoid muscle

Hypoglossal nerve

Superior belly of omohyoid muscle

Anterior belly of digastric muscle


A 21 year old develops tonsillitis. He is in considerable pain. Which of the following nerves is responsible for the sensory innervation of the tonsillar fossa?

Facial nerve

Trigeminal nerve


Hypoglossal nerve

Vagus


A man has an incision sited that runs 8cm from the deltopectoral groove to the midline. Which of the following is not at risk of injury?

Cephalic vein

Shoulder joint capsule

Axillary artery

Pectoralis major

Trunk of the brachial plexus


A surgeon is due to perform a laparotomy for perforated duodenal ulcer. An upper midline incision is to be performed. Which of the following structures is the incision most likely to divide?

Rectus abdominis muscle

External oblique muscle

Linea alba

Internal oblique muscle

None of the above


A 59 year old man is undergoing an extended right hemicolectomy for a carcinoma of the splenic flexure of the colon. The surgeons divide the middle colic vein close to its origin. Into which of the

following structures does this vessel primarily drain?

Superior mesenteric vein

Portal vein

Inferior mesenteric vein

Inferior vena cava

Ileocolic vein


Theme: Nerve Injury

A. Median nerve

B. Ulnar nerve

C. Radial nerve

D. Musculocutaneous nerve

E. Axillary nerve

F. Anterior interosseous nerve

G. Posterior interosseous nerve For each scenario please select the most likely underlying nerve injury. Each option may be used once, more than once or not at all.

236. A 10 year old boy is admitted to casualty following a fall. On examination there is

deformity and swelling of the upper arm. The ability to flex the fingers of the affected

limb is impaired. However, there is not sensory impairment. Imaging confirms a

displaced supra condylar fracture

237. A well toned weight lifter attends clinic reporting weakness of his left arm. There is

weakness of flexion and supination of the forearm.

238. An 18 year old girl sustains an Holstein-Lewis fracture. Which nerve is at risk?


A 23 year old man is stabbed in the chest approximately 10cm below the right nipple. In the emergency department a abdominal ultrasound scan shows a large amount of intraperitoneal blood. Which of the following statements relating to the likely site of injury is untrue?

Part of its posterior surface is devoid of peritoneum.

The quadrate lobe is contained within the functional right lobe.

Its nerve supply is from the coeliac plexus.

The hepatic flexure of the colon lies posterio-inferiorly.

The right kidney is closely related posteriorly.


A 22 year old man is involved in a fight and sustains a skull fracture with an injury to the middle meningeal artery. A craniotomy is performed, and with considerable difficulty the haemorrhage from the middle meningeal artery is controlled by ligating it close to its origin. What is the most likely sensory impairment that the patient may notice post operatively?

Parasthesia of the ipsilateral external ear

Loss of taste sensation from the anterior two thirds of the tongue

Parasthesia overlying the angle of the jaw

Loss of sensation from the ipsilateral side of the tongue

Loss of taste from the posterior two thirds of the tongue


A 72 year old man presents with haemoptysis and undergoes a bronchoscopy. The carina is noted to be widened. At which level does the trachea bifurcate?

T3

T5

T7

T2

T8


A 23 year old man is injured during a game of rugby. He suffers a fracture of the distal third of his clavicle, it is a compound fracture and there is evidence of arterial haemorrhage. Which of the following vessels is most likely to be encountered first during subsequent surgical exploration?

Posterior circumflex humeral artery

Axillary artery


Sub scapular artery

Lateral thoracic artery


The following are true of the femoral nerve, except:

It is derived from L2, L3 and L4 nerve roots

It supplies sartorius

It supplies quadriceps femoris

It gives cutaneous innervations via the saphenous nerve

It supplies adductor longus


Where is the vomiting centre located?

Medulla oblongata

Substantia nigra

Antrum of stomach

Pons

Midbrain


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


Which of the following nerves passes through the greater sciatic foramen and innervates the perineum?

Pudendal

Sciatic

Superior gluteal

Inferior gluteal



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 semitendinous muscle

Causes extension of the knee


Theme: Nerve lesions

A. Sciatic nerve

B. Peroneal nerve

C. Tibial Nerve

D. Obturator nerve

E. Ilioinguinal nerve

F. Femoral nerve

G. None of the above Please select the most likely nerve injury for the scenario given. Each option may be used once, more than once or not at all

248. A 56 year old man undergoes a low anterior resection with legs in the Lloyd-Davies

position. Post operatively he complains of foot drop.

249. A 23 year old man complains of severe groin pain several weeks after a difficult inguinal

hernia repair.

250. A 72 year old man develops a foot drop after a revision total hip replacement.


A 38 year old man falls onto an outstretched hand. Following the accident he is examined in the emergency department. On palpating his anatomical snuffbox there is tenderness noted in the base. What is the most likely injury in this scenario?

Rupture of the tendon of flexor pollicis

Scaphoid fracture

Distal radius fracture

Rupture of flexor carpi ulnaris tendon

None of the above


A 25 year old man sustains a severe middle cranial fossa basal skull fracture. Once he has recovered it is noticed that he has impaired tear secretion. This is most likely to be the result of

damage to which of the following?

Stellate ganglion

Ciliary ganglion

Otic ganglion

Trigeminal nerve

Greater petrosal nerve


Which of the following structures passes through the quadrangular space near the humeral head?

Axillary artery

Radial nerve

Axillary nerve

Median nerve

Transverse scapular artery


Which of the following pairings of foramina and their contents is not correct?

Superior orbital fissure and the oculomotor nerve

Foramina rotundum and the maxillary nerve

Jugular foramen and the hypoglossal nerve

Foramina spinosum and the middle meningeal artery

Carotid canal and the internal carotid artery


A 55 year old man with carcinoma of the larynx is undergoing a difficult laryngectomy. The surgeons divide the thyrocervical trunk, from which of the following vessels does this structure most commonly originate?

Subclavian artery


Vertebral artery




The following structures are closely related to the brachiocephalic artery except:

Trachea posteriorly

Right brachiocephalic vein

Inferior thyroid vein

Right recurrent laryngeal nerve

None of the above


Which of the following structures separates the ulnar artery from the median nerve?

Brachioradialis

Pronator teres

Tendon of biceps brachii

Flexor carpi ulnaris

Brachialis


Which muscle is supplied by the superficial peroneal nerve?

Peroneus tertius

Sartorius

Adductor magnus

Peroneus brevis

Gracilis


A 32 year old motorcyclist is involved in a road traffic accident. His humerus is fractured and severely displaced. At the time of surgical repair the surgeon notes that the radial nerve has been injured. Which of the following muscles is least likely to be affected by an injury at this site?

Extensor carpi radialis brevis

Brachioradialis

Abductor pollicis longus

Extensor pollicis brevis

None of the above


A man develops an infection in his external auditory meatus. The infection is extremely painful. Which of the following nerves conveys sensation from this region?

Occipital branch of the trigeminal nerve

Vestibulocochlear nerve

Facial nerve

Auriculotemporal nerve

Maxillary branch of the trigeminal nerve


Which muscle is responsible for causing flexion of the interphalangeal joint of the thumb?

Flexor pollicis longus

Flexor pollicis brevis

Flexor digitorum superficialis

Flexor digitorum profundus

Adductor pollicis


Which of the following structures separates the posterior cruciate ligament from the popliteal artery?

Oblique popliteal ligament

Transverse ligament

Popliteus tendon

Biceps femoris

Semitendinosus


How many compartments are there in the lower leg?

2

1

3

5

4


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


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


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


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


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


A 25 year old man undergoes an excision of a pelvic chondrosarcoma, during the operation the obturator nerve is sacrificed. Which of the following muscles is least likely to be affected as a result?

Adductor longus

Pectineus

Adductor magnus

Sartorius

Gracilis


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 ?


Portal vein


Liver bed



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


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


Which nerve supplies the 1st web space of the foot?

Popliteal nerve

Superficial peroneal nerve

Deep peroneal nerve

Tibial nerve

Saphenous 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?



Coeliac axis




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


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


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


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


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 to the 4th interspace 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


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


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.


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


Which of the following is not a branch of the hepatic artery?

Pancreatic artery

Cystic artery

Right gastric artery




Which of the following structures does not pass behind the piriformis muscle in the greater sciatic foramen?

Sciatic nerve


Inferior gluteal artery

Obturator nerve

None of the above


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


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


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


Which of the following muscles does not adduct the shoulder?

Teres major

Pectoralis major

Coracobrachialis

Supraspinatus

Latissimus dorsi


Which of these muscles is innervated by the cervical branch of the facial nerve?

Masseter

Sternocleidomastoid

Platysma

Geniohyoid

Sternothyroid


During a thyroidectomy the surgeons ligate the inferior thyroid artery. From which vessel does this structure usually originate?


Thyrocervical trunk


Subclavian artery

Vertebral artery


A 56 year old man is left impotent following an abdomino-perineal excision of the colon and rectum. What is the most likely explanation?

Psychosexual issues related to an end colostomy

Damage to the sacral venous plexus during total mesorectal excision

Damage to the left ureter during sigmoid mobilisation

Damage to the hypogastric plexus during mobilisation of the inferior mesenteric artery

Damage to the internal iliac artery during total mesorectal excision


A 73 year old man is due to undergo a radical prostatectomy for carcinoma of the prostate gland. To which of the following lymph nodes will the tumour drain primarily?

Para aortic

Internal iliac

Superficial inguinal

Meso rectal

None of the above


Which of the following statements relating to the vertebral column is false?

There are 7 cervical vertebrae

The cervical and lumbar lordosis are secondary curves developing after birth due to

change in shape of the intervertebral discs

The lumbar vertebrae do not have a transverse process foramina

The lumbar vertebrae receive blood directly from the aorta

The spinous process is formed by the junction of the pedicles posteriorly


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


A 73 year old man undergoes a sub total oesophagectomy with anastomosis of the stomach to the cervical oesophagus. Which vessel will be primarily responsible for the arterial supply to the oesophageal portion of the anastomosis?



Direct branches from the thoracic aorta


Subclavian artery


Which of the following structures is not closely related to the brachial artery?

Ulnar nerve

Median nerve

Cephalic vein

Long head of biceps

Median cubital vein


Theme: Anatomy of the abdominal aorta

A. Common iliac artery

B. Median sacral artery

C. Left renal artery

D. Right renal artery

E. Inferior mesenteric artery

F. Superior mesenteric artery

G. Coeliac axis

H. Lumbar arteries Please select the branch of the abdominal aorta that most closely matches the description provided. Each option may be used once, more than once or not at all.

297. An aortic branch that leaves the aorta approximately 1cm below the coeliac axis.

298. The most inferior single branch of the aorta.

299. The most inferior anterior branch of the aorta.


Which ligament keeps the head of the radius connected to the radial notch of the ulna?

Annular (orbicular) ligament

Quadrate ligament

Radial collateral ligament of the elbow

Ulnar collateral ligament

Radial collateral ligament

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