TO SURGERY:- ACCESS ANSWER 5OO SINGLE BEST lN BASIC_AND QUtsTloNs ANATOMY APPTIED Shahzad G' Raia BSC, MBBS, MRCS Specialist Registrar in Cardiothoracic Surgery Depaltment of Cardiothoracic Surgery Clasgow CONTENTS vil Preface IX Abbret iotion" Questionr I 3 and Breast a;l)PPerLimb f-Jorurrlimb V 23 .{.**r,oru"} 43 65 \ .."-Sbdomen ***felvis 1' 103 and Neck L 115 -.Head {^ / -xuinand Cranial Nerves J' 157 165 sPinalCord L'. }eurl^and '- 173 DerreloPmental AnatomY Answers .l9l Upper Limb and Breast 221 Lorver Limb 253 Thorax 279 AMomen 329 Pelvis 317 Head ancl Neck 419 . Brain and Cranial Nerves 435 Back.rnd SPinal Cord 447 DeveloPrrental An.rtomY 471 lrttlcx 'I SECTION : - AND LIMB BREAST UPPER .a) |. r QUESTIONS For each question given below cltoose tlrr ONE BEST option' Ann) 3 1.1 While performing a radical mastectomy' :l:,-* surgeon iniured the long thoracic nerve' YYrrrsr' of the following musclei wlll be af fected due to iniury to the long thoracic nerve? o A Anterior scalene o B Middle scalene o C Serratus anterior o D SubscaPularis o E T€res maior I accident t.z\ A motorcyclist involved ln a hit-and-run was thrown from his motorcycle' He landeo . r1 ;;;;; t;eht side of his head and the tip "1L'"t --" ,1$,.. sh ou I d erl bend i nI hi s h ead sh a r p ly -to-t| " 111::1" stretching the right side of his neck' Sublequenr ;;;i;;i.at exa-minatlon revealecl th-at l:"tt lT-"- of the fifth and sixth cervical nerves had been ffi port ot '"llr torn away from the spinal cord' What fi ti" .tpp.t limb will have diminished cutaneout fi, sensations in this Patient? frri .# o A The back of the shoulder hfi,' o B The top of the shoulder and the latrrrtrl sidc of thc arm o C The Pectoral region ffi c ;li D The nredial side of the arm and f .JrLr'lrm c E The tiP of the little finget 1i l!., d- *Ctll t.r tul('l rll'- I fllctured the 'l,l A7 ulni. ttre llne of 1.6 Brancher of the trr'rchial artery <ontribute to the ohc; riarlor s0rface and anartomotic circulation around the: ' iiurckl. Which of o A Acromioclavicularioint i[ ttr.ty rffected? o B Elbow joint l|^-t E!=o I Brachlalll r '::'1 ,eer,' t o C Glenohumeral ioint ' C '{O B rlexor dlgliaum Fnfultlul ' ' o D Head of the humerus rc-) =o C Flexor Polll€h longul o E ScaPula -o1- d-o ) D Pronatot tltll o E TricePc brrchll 1.7 A rugby player sustalned lniury to his right ,upririinuius muscle' tniury to the supraspinatus 1.4 A[; ;m;;o;itlocrecdyc llrt tfheallt feroxmten hsllro nb lkoef ' hOisn r aigrhrltv ahlu mine Aru6rsE o mAu Ascdldeu cwtiiolln aofff ethcet :humerus inlury to ;; ;";;;"ij tt-tt"o' He has sustained o B Abduction of the humerus above the horizontal plane , the: i', o C Lateral rotation of the humdrus c A Long thoracic nerve' o D lnitiation of abduttion of the humerus o B Medial Pectoral nerve o E SuPerior rotation of the scaPula o C SuPrascaPular nerve o D ThoracodorsaI nerve 1.8 While performing martectomy' the surgeon o E UPPer subscaPular nerve fraTi lerydJ + fs! ' b/ttt ;;i;;J in" lut""il thoracic arterv' rhe lateral l:i thoracic arterY: i.: 1.5 A;" "y;o;u;;n g buoi'ya felt from hhiiss saknantuelbaor alirgda' mtweisntte' Tdh heis tr oo AB llss aa bbrraanncchh ooff tthhee sburabcchlaivaila anr taerrYtery 'p'ui"ed unn.rtut ligament in the forearm: I C Acconrpanies the long thoracic nerve to the serratus coAB EEnncciirrcclleess tthhee hheeaadd ooff tthhee. rualndaius o D Aaannctcteeorrniiootprr amnnuiresusc lsethcel eth oracodorsal nerve to the serrat"J "*t oocD ECnoceisrc fl eros ntrh eth est yolloeicdr apnroocne fsoss soaf tthoe t hrea doiulescranorl process I o E Ernerges through the triangular sPace $' oE Spans the space between the ulna and radius ,ffi, ffi tl; :{. l,ir lT L Q{-f S-l'lOi'iS uqjiil llll ll ll-ll:l):l!3!!19.[l-l]l! ^':?-:l-tjl? uy!1-]11 rgcEsug :L.]:l /\ 1.9 Ayoui"n"Ag ig'pyrmesnsa stth esu gslteaninoeidd fionsiusary d.tior' e"c tTly"' ::w!-h"l.cthlot { t.tz W"iiht.l,cih"" o f thoef fthoello cwliginit-gs sotfa ttheme ehnatnst-l riesg caOrdRiRngE(T? ".'at r.iiowlng is Jmuscte that acts to depress o A The palmar interosseous mttscles are tha sole zdductors "thi-eir gt.le nold fossa directlY? of the digits oo AB PSeercrtaotruasl isa nmteinroiorr oI BC TThhee relu marber ticvarolm muussccleless ptrhoadtt rpcreo daudcdeu catdiodnu cotilo tnlt go fO tihSeltl "FEc) thumb ,(]- o C Pectoralis maior o All of the adductors of the digits take at leasi part of c>- o D Latissirrtus dorsi their attacfrments f rom meta-arpal bones o E SuprasPinatus i!L\. o Adduction of the digits will be af fected by carpal r tunnel sYndrome 1.1O The common flexor teridon of the foreaim wfoalslo awviunlgse md ufrsocmles itosr iagtintdacthems efrnotm' W thhelc cho omf mthoen 1.13 A vlcttm of a road traffic accident has a severed flexor tendon of the forearm? of adduction o-f ull ihe digits of the right hand' o A FleNor digitorum suPerficialis wht;; nerve controts addirction of att the digits of the hand? o B Flexor digitorum Profundus o C Flexor Pollicis longus L,: @ A Ulnar nerve : o D Pronator quadratus o B Median nerve o E Extensor carPi ulnaris o C Radial nerve ,,,i4;t PT, FCz,t'FCu;FL; €D$ Lo't'u^*^ PtePn o D UpPer subscaPular nerve L will o E Musculocutaneousnerve @'." Which of the following muscle'comtinations work together to abduct the wrist? t o A Pronator teres and brachioradialis D;;u;tr;in g sou.r'g,!einryu ttiot gre fmroomve t hae l ulmatpe rfarol.cmo rtdh eo faxilla' u o B Palnraris lgngus and extensor digitorum it,e UracniJ plexui was iniured'Which of the { o C Extensor carpi radialis brev'is and flexor carpi radialis following nerves originates from the lateral cord \' o D Extensor carpi radialis brevis and extensor carpi ulnaris of the brachial Plexus? N--lO0 o E Supinator and extensor pollicis longus o A Uln.rr o B Meclirl Pectoral ffL t EIe\,EtRhi FtFi ; Extoas'rrrhu'ral o C Sr.rPrascaPular o D Later.rl Pectoral o E Thorrcodorsal Lo{ ^ronl f t*{r4.'r' I'rU. <p, 1?l r.,.! " ,,.1 ,;',-'"" t o 6n.Br ED; FDM. A; Bco Eff,r'EIRB, (lr JL s'r r()NS r.CC€55 10 SUll(,t ll\': 5(r(r Sll'lCL[ ltl'5T At'!\\ t R \]Ut 5 Tl("rl{S l!'J t\ \.(lC '/\tlt) ^r,t'L rt t) '\\ 'J(\l.l\ plexus I 1.18 The prlmary ventral rami of the brachlal rl {.*orf l.fs- A rugby player sustained spinal cord iniury at (raml = roots): . tplnit ievet CS. What ls likely to be seen in thls o A Enrerge from between tle middle arrd posterior scalette Patlent? :muscles / -o o A The br.achialis muscle rvillbe paralysed o B Are formed from spinal levels C7 to T3 o B- The mr,tscles itrnervated by the radial nerve that rvould o C Do not give rise to any nerves directly most likely be af fected rvould be the most proxirrral o D Fbrm the trunks of the brachial plexus ,qo,- o C oTnhee 5hypothenar muscles rvould be conrpletely paralysed o E Corqbine to form the cords of the brachial plexus o D lnnervation to the deltoid rnuscle would be affected o E The patient, would be unable to f lex their humerus t.l9 The'muscle producing tFe main movement of the proximal radioulnar ioin't was paratysed following I stab wound to the cubltal fossa' Which of the Tcohen tianintesr ttuhbe:ercular groove of the humerus ., ....f,o* ll;oiw; int.gS tmguglcltle-"sd pirpo"dsutcneas rthiseb mlra) inp mf oi;v 'e;imfi$ern it i oA Tendon of the pectoralis minor muscle O A Extensor carPi ulnaris ir', \ oB Tendon of the long head of the triceps brachii muscle O B Pronator teres . ii,'' oc Tendon of the coracobrachialis muscle od O C TricePs brachii oD Tendon of the short head of the biceps brachii muscle O D Brachioradialis oE Tendon of the long head of the biceps brachii muscle O E Brachialis 1.77 A young man Pretented in AEIE foltowing a street 1.20 Wtrlch of the following statements is CORRECT fiqht with proft'tt" bleeding from the superior regarding the extenror retinaculum of the wrist? collateral artery is a'direct branch of which o A tG a aireit extension of the axillary fascia arterY? o B The median nerve runs deeP to it ' o A o C The tendon of the brachioradialis muscle runs through Ulnar it ot B Radial (_ o D lt contains a compartment for the thenar muscles' C Braclrial .. >\\" o E lt prevents the tendons of the posterior comPartment o D Profunda brachii \' of the forearm from 'bowstringing'when the hand is c E AxillarY extended at the wrist \lLtl sTloNs APr'll!!l:liul1.'nll tt-.:-'., t() 1,,j.r(,rrr.i': 51rt lllgltjli-.r-n"5'gt'lj::ilgllil:111.D 1,24 A patlent has a fall on outstretched hand and ',.21 Tcou bclltraatw v teoinm eyo bul owoitltl flrnosmer ta tphae tnleenetd'sl el nlne dtihaerr: nr fthriect udlrsetsa l ae nbdo noef tahte t hread wlursls at iftolctuntta-wteltsh pwrlJmrlcahr.l,ly .,,, ;':i\, i*i"i.$,e wrtst ls ln the anatornlcat posltlon)' i 'rf r' (J. OOO ABC PFDeoomsrsteoarrlia oslr u qraf!as:Pclege coLt fot t fh telr erh. a kn.n.d e;e" " . .- . O WA hTlcrihq ubeotrnuem ls fractured? ,,r - qLq'- 'r_ALo' L' - D Anterior asPect.of the elbow O B CaPitate 'oo)- CD O E DeltoPectoral tiiangle @ C ScaPhoid G' 3(t O D Pisiform t:. ia: d if When yoq rest your etbo.wt on a desk' what bony O E TraPeziurn ,"'l ,\' L# ;;il;;;k;;.h1uPPer limb are vou restine on? f O l''uJ?Y'f,&- u/**,// O A styroid process. of the radius ,.rldrnj,ot+o- 1.25 What sort of a synovial iolnt is the elbow? .{ o B Detroid tuberosity of the humerus roA"tdP:(€' O A ElliPsoid - c " F" 'B . olecranon Process :1:nt :ll' O Hinge | , o Coronoid Procdss of the ulna O C Ball and socket O E Radial tuberositY O D Plane E O BicondYlar 1.23 You examine a patient who has a rotatoorf cas#u h;mf: o;fui u;is#nlcal;uu'.:r,l;lyo;"';*r ;rif;O iuth ierti tairoaor" itssa" o tconurrf -tcrf tussfu for rcafo ontuhmdne pod rsnlinsueegp so r tathhseep rl-n matuussc' re.' 'm\\ -\/ ' I Awtih" hter"oi ciahihidr" fg nrteer saruouflfnstie .<t do Wa ltchnhci ecliod hsc esrnne eots rftvv eiaoc cfti istmti hodn eai nmloeiuafs grsteheederd ?tamu bunesecrrclvetee ' o'f Whtch muscle is that? ', -. A O Radiai o A Deltoid O B Long thoracic l'. o B Subclavius O C Median il\I o C Long head of the bicePs brachii a D Lower subscaPular O D Teres minor E O Axillary o E' Coracobrachialis l1 1_ \lt rl 5I l(.rii5 APPLII!"iI!'lI Ar r [!'r I{) SUR#R\': 500 S]i:cll'gtlltYtrr' tu'ltiIlOtl't Itl?'^SlC ANo 1.3O Am upracthlo. nAt nh oanr olpigoessmlc olsf !lhn-lee clatetidss llnmtuos t hdeo rmsiedlan 1.27 Anoloe fsb rtlvuh eoicl df t:fehtrta '-tf "eitsllt t p'f-roioiiitmse r ?io lwr" gotouttt t:tth: ema nomdse tt dtlaiikamel aleygp erldceo ostnfuh ddletyi g lie'ints 4" ctitayhLurlr ttobtrrhrullltcfgnlt lch lla av tttrlehhlly6qirl. u m whelmnuhecesaaen rg dtc lfoneaor enrsld t l tt hhgmlsoe: iue gta'sshtnch ellanenet t 'g doaled lnssteahltcnrleg itb teihofusye ltrc aeea rad ltscc' ohf- -rl orthewcaitntg tr -=t;or -Co o A Extension of the metacarpophalangeal ioints mutclc, startlng at the subclavian artery' qo)- -o ancl 5 o- (' u ri..ion in the distalinterphatangeal ioint of digit 5 @ A Subc)avian-axillary-iubscapular-thoracodorsal J -t Oo C Abduction of the thumb (digit 1) O B Subclavian-axillary-acronrioclavicular*acrorrrial 3o o D Gtheennearar le cmuitnaennecoeus sensation f rom the skin overlying the OO CD SSuubbccllaavviaiarnr -- aaxxiillllaarryy -- sthuyprroecrneerv tihcaolr atcruicn k- -intercostals Ti."-'\ .'t\, o E Function of lumbricals 1 and 2 suPrascaPular O E Subclavian - costocervical trunk - suprascapular 1.2A Aftoh erpr anstsci aetpnhutt Is Puu's;-;"ta; ;iin;tlte""dt pduwalaal -tral is9J -rme i'un'l oes c ala 9mx ^iaullnsadc laetel ortnehgsa twmiathlor 1.31' W,tphriuchr. uoPf uthlaer fonlelorvwei.nisg csotRaRteEmCeTn?ts regarding the wrrictr muscte is damaged? -"t.i"' O A lt courses superior to the suprascapular ligament en C A Latissimus dorsi route to the supraspinatus muscle O B TraPezius O B lt contains nerve f ibres from C5 and C6 spinal cord maior O C Pectoralis segments I 5 D Serratus anterior' +/^' O C lt in;rervates the teres minor muscle' E SuPrasPinatus : O D ft y'rovides cutaneous innervation to the posterolater rl 5 surface of the shoulder urs 1.2g A patlentp irnti"u"rte d the postertihorro cwonrd o offf' tthhee back O E lt branches f rom the middle trunk of the brachial plexus $ brachlal "ri";;;ttg The posterior cord soef atht eor b ur a'icJiJtuiitf "pito-utot"t tg-.y"lcAlte-u' ]lt contalns nerv€ of ttie spinal cord? fibres from wfrlctr tevel(s) o A C5 onlY o B C5, C6 and C7 I C C5, C6, CZ C8 and Tl o D C7, C8 arrd T1 o E CS and T1 ?ib 0 rl.'i \ I l(t'i! \, ( .1,', t(, !l'j1i:Il-l t":':-:::i '::-:!!ljgtUU l"l t"5'llgjl$'j:.n')I G .irpatlcnt sustalned a fracture of the humerus of severe 'plns antl needles' and lnfured the nerYe that lnnervates the nruscles O 1.72 Asl"e rtnyisip .ritsiot nc,sno emo npth ttauhimnes bd oarnsudm p aorft sh oerf lcelifg ti ths aql'da'n dover onef rtvhee las nlntefurrloerd ?conlpartment of the arm. Whlch !:;i';; "i ;iysical examlnatlon' the patient o A Median -o ;;;l;;;t;ess of wrist dorslflexlon and finser I B € C 'j.;.';;;;;. wrtitrt ner'e k most likelv to be ' lvtusculocutaneous t-' ETJ o C Radial ' . a) Q iniured? o D Ulrrilr' CoI-- -1 A :l =7Oo Ulnar o E AXillary B Radial o C ,/,:\ Musculocutaneous o D AxillarY' f r.rd A patlent injured the nruscle that is an antagcnist ihas an opposlng action) to the serratus anterior o E Median muscle, whlch ls the primary protractor of tlre scaputa. Which muscle is iniured? 1.33 A;c"o "r;ur"ar;s;ti;ee;irn ept sowfusraitltetchirtn iuotIhrrieen dt " thttIeta" c mtne"eer"aOdrvtiiaieoal'n l eW epLptitrci iccottonntn daadyrryltteleee rr oyyof fti tshhthaeet ooo BC,4, .[RL,eehcvotamotrobaro liissdc ramnpiuanljoaorr Frl.fI'c.t t$ \ humerus. "f ""t o 0 la cerated? Supraspinatus o A SuPerior ulnar collateral ; c E Deltoid o B Anterior ulnar recurrent o C Radial collateral 1.37 A .S2-year'old woman underwent a radlcal o D Middle collateral mastectomy to remoye her teft breast and all of the axillary lymph nodes on that side due to o E lnterosseousrecurren breast cancer. Postoperatively, the nurse giving : her a bath noticed that she had a 'r'rlinged scapula' 1.34 The quadrangular space -"f -tbhy" tshheo uteldreesr ims aainor odna mthaeg ele tfot :side. This appearance is a result of anatomicat ;;;;;;' m'"g"ii'ote"'t'o l"o"ndse hde ad "l toqfu thtrelc ehPusmerus' o A Axillary nerve u"J kilr:r;a;c;h;.ii musiocnlet or"i "ln'fJitaaxl-itntaercvk n erve and the: o B Musculocutaneousnerve ooo ABC fPCRoiarsdcuitaemlr ifno elrer xvc eirscct'trnPruflleaxr ahrutemrYeral artery brqt/d.,. ooo CDE LMt.ooewndgeia rt ll tspouerbacsctcoiacrpa unl leannre ,crnveerve o D DeeP arterY of the arm o E nerve Thoracodorsal t) h. '"t I I _qurllt!lNs A(:(.t55 TO SI.JRCIRV s(tQ S|;LLl S{5T Ar'rs$/tR QUISIIONS lu BAS|C ArrD APPL'Et AilArOLry r'4o Aftcr a pcnetroting'rvound rn the aren of trre 1.38 A young boy f ell from hlr bike and clislocated posterlor oxlttary fold, a pattent h;;;;;r.;;r, r i..iilr *, , thc proxlmal radioulndr iolnt and stretched the tn extenrlon and adductlon of the arm. Whlch 1 ;;l. :$"i'ti:' annular ligament. This iniury will make which' muscle b llkely to be lnvotvJ?- , -q;. €o movemeri t v er Y Palnful? ? A L.atissirfius dorsi . -O.-1' r-*i.:J:!, A o B (''!''"' Eo Elbow flexion Pectoralis major a- lll b ti, lo B Supination o C Levator scapula h,:ot;*', l:i' C o D Elbow extension Rhorirboideus nrajor O. c3t0o D Shoulder abduction o E Trapezius oJ- E Radial deviation qf the wrist #/ A 28-year-old man suffered a Mbnteggia fracture $7 (\/*i.Y.)^ G\-/ Danurrl'ilnagn dae tdr iawthithlo nth eb ihkianngd laecbcaidr eonft ,h ea rr ibdieker ffeolrtced WJ'' - F:1o,l:lhow" ienlgb othwls-i ohien ti si nu naa rbolaed t otr aexfftiecn da cthceid wenrits. t *! It I - usthwpawimt4 mhrdel nr lgnri tgoinh htb eanrrg mrtihg tehirrte tdarlx asltlotha lb.o aSndu lyeb vsdeeunqruti nesnghte lty hf,o euwnhdile bsaeen ndtso ma ttehlotean:csa arpreo pinhtaa clatn; gtheea l djaomlnatsg,e a llst fmroousgif ,i iitlf"reiy ao swimmlng portion that she could barely finish o A the event. During examination, it was found that g Radiat nerve o moyements invotving adduction, medial rotation v"aiun:n.rJ" a.nd extenslon of her arm were pdrticularly weak 'O C Ulnar nerve ) . and affected her swimming stroke. The nerve o D Anterior interosseous nerve lnjured was the: ( C E Posterior interosseous nerve o A AccessorY ^$ o B Dorsal scaPular o C Lateral Pectoral -"uY'Ntd v2 tAh e4n2a-yr eeamr-ionledn cweo, mbaunt dth-eev e,"lonprsu taiotrrorpLhvye ro ift the O D Medialpectoral intactl the damage is most,ik.tyi; ;;;'il., is o E Thoracodorsal o A Median nerve o B Ulnar nerve o C nerve Radial '. o D Musculocutaneusnerve o E Axillary nerve l<r I