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Question 1
Correct
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A 40-year-old woman presents with retrosternal central chest pain that she has been complaining about for the past two days. Upon deep inspiration and while lying flat, the pain worsens but relieved by sitting forwards. The pain radiates to both of her shoulders. The result of her ECG shows widespread concave ST-elevation and PR depression. A diagnosis of pericarditis is suspected. Which of the following nerves is responsible for the pattern of her pain?
Your Answer: Phrenic nerve
Explanation:Pericarditis is inflammation of the pericardial sac and is the most common pathologic process involving the pericardium. Frequently, pericardial inflammation can be accompanied by increased fluid accumulation within the pericardial sac forming a pericardial effusion, which may be serous, hemorrhagic or purulent depending on aetiology. The classic presentation is with chest pain that is central, severe, pleuritic (worse on deep inspiration) and positional (improved by sitting up and leaning forward). The pain may also be radiating and may involve the ridges of the trapezius muscle if the phrenic nerve is inflamed as it traverses the pericardium.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 2
Incorrect
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An infant, 5 weeks and 6 days old born with a large sub-aortic ventricular septal defect, is prepared for pulmonary artery banding through a left thoracotomy (the child is not fit for a surgical closure). The surgeon initially passes his index finger immediately behind two great arteries in the pericardial sac to mobilise the great arteries in order to pass the tape around the pulmonary artery. Into which space is the surgeon's finger inserted?
Your Answer: Coronary sulcus
Correct Answer: Transverse pericardial sinus
Explanation:Cardiac notch: is an indentation on the left lung of the heart. Coronary sinus: a venous sinus on the surface of the heart (the posterior aspect) that receives blood from the smaller veins that drain the heart. Coronary sulcus: a groove on the heart between the atria and ventricles. Transverse pericardial sinus: located behind the aorta and pulmonary trunk and anterior to the superior vena cava. Oblique pericardial sinus: located behind the left atrium. Accessed from the inferior side (or the apex) of the heart upwards.Horizontal pericardial sinus: this is a made-up term.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 3
Incorrect
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Regarding the anatomical relations of the scalenus muscles, which of these is true?
Your Answer: The subclavian vein forms the brachiocephalic vein at the lateral border of scalenus anterior
Correct Answer: The trunks of the brachial plexus emerge from the lateral border of scalenus anterior
Explanation:The ascending cervical artery lies media the phrenic nerve on scalenus anterior and can easily be mistaken for the phrenic nerve at operation.The phrenic nerve passes across scalenus anterior and medius inferiorly.The subclavian artery is separated from the vein by the scalenus anterior.The brachiocephalic vein is formed at the medial border of scalenus anterior by the subclavian vein and the internal jugular vein.Emerging from the lateral border of scalenus anterior are the trunks of the brachial plexus .
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 4
Correct
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The following statements concern the sensory innervation of the nasal passage:
Your Answer: the infraorbital branch of the maxillary nerve supplies the vestibule
Explanation:The walls of the anterior nasal passage are supplied by the anterior ethmoidal branch of the nasociliary nerve, and the floor is innervated by the superior dental nerve (not the sphenopalatine nerves). The walls and floor of the posterior nasal passage are innervated by the long and short sphenopalatine nerves and the great palatine nerve (not the superior dental nerves and the nasociliary nerve). The vestibule is innervated by small branches of the infraorbital branch of the maxillary nerve. The nasopharynx is innervated by the sensory branches of the trigeminal nerve (not the great palatine nerve).
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 5
Correct
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Regarding the hard palate, which of the following statements is CORRECT:
Your Answer: Lymphatic vessels from the palate usually drain into deep cervical lymph nodes.
Explanation:Lymphatic vessels from the pharynx and palate drain into the deep cervical lymph nodes.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 6
Correct
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Which of the following foramina provides a passage through which the vestibulocochlear nerve, passes?
Your Answer: Internal acoustic meatus
Explanation:The internal auditory meatus is a canal within the petrous part of the temporal bone of the skull between the posterior cranial fossa and the inner ear. It provides a passage through which the vestibulocochlear nerve, the facial nerve, and the labyrinthine artery (an internal auditory branch of the basilar artery) can pass from inside the skull to structures of the inner ear and face.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 7
Incorrect
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During an operation to repair an aortic coarctation in a neonate, a surgeon accidentally cuts the first aortic intercostal arteries as he mobilised the descending aorta. Which one of the following structure might be deprived of its primary source of blood supply following this injury?
Your Answer: First posterior intercostal space
Correct Answer: Right bronchus
Explanation:The right bronchus is supplied by one right bronchial artery that may branch from one of the left bronchial arteries or from the right 3rd posterior intercostal artery (this is the first intercostal artery that arises from the aorta). Damage to this artery might stop blood supply to the main bronchus. Intercostal arteries that go to the first and the second interspaces originate from the highest intercostal artery such that blood supply to either of these spaces would not be interfered with.The left bronchus receives blood from 2 left bronchial arteries which are direct branches from the descending aorta. Fibrous pericardium is the sac that contains the heart. Its blood supply is not a major concern. Visceral pericardium receives its blood supply from the coronary vessels.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 8
Incorrect
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A 41-year-old man, with symptomatic tracheal compression is scheduled for a thyroidectomy. He has previous personal history of hyperthyroidism, controlled by a carbimazole prescription. He has previously presented to the emergency department with dyspnoea and stridor, for which the surgery is indicated. Prior to his thyroidectomy, excessive bleeding is controlled for by ligation of the superior thyroid artery. The superior thyroid artery branches into the superior laryngeal artery which is closely related to a structure which upon injury will cause loss of sensation in the laryngeal mucosa. What is the name of this structure?
Your Answer: Right recurrent laryngeal nerve
Correct Answer: Internal laryngeal nerve
Explanation:The internal laryngeal nerve provides sensory innervation to the laryngeal mucosa, and injury to it will cause loss of sensation. The internal laryngeal nerve lies inferior to the piriform recess mucous membrane, placing it at high risk of irritation or damage by objects which become lodged in the recess. The internal laryngeal artery branches off the superior laryngeal artery accompanied by the superior laryngeal nerve, inferior to the thyroid artery which branches off the superior thyroid artery close to its bifurcation from the external carotid artery.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 9
Incorrect
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Post thyroidectomy, a 50-year-old male singer noticed some hoarseness in his voice. Now, he presents to his general physician as it has been the same for the past few weeks. A complication is noted in the post-thyroidectomy report regarding an injury to the external laryngeal nerve. Which muscle has been affected due to loss of innervation by the damaged nerve, and whose improper functioning can lead to hoarseness in the patient's voice?
Your Answer: Posterior cricoarytenoid
Correct Answer: Cricothyroid
Explanation:All of the muscles of the larynx are innervated by the recurrent laryngeal nerve, except the cricothyroid muscle. Cricothyroid muscle is located deep in the anterior neck, between the cricoid and thyroid cartilage and is innervated by the external laryngeal nerve. Any injury to this muscle can cause paralysis and lead to hoarseness. When cricothyroid muscle contracts, it leads to tightening, stretching and thinning of the vocal folds. This produces higher-pitched sounds during vocalization. A patient experiencing hoarseness due to possible injury to the external laryngeal nerve should be reassured that the hoarseness will resolve in time due to increased compensation from the other muscles.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 10
Correct
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Which muscle in the neck divides the neck into two large triangles?
Your Answer: Sternocleidomastoid
Explanation:The sternocleidomastoid muscle is an important landmark in the neck as it divides the neck into two; anterior and posterior triangles. These triangles help in the location of the structures of the neck including the carotid artery, head and neck lymph nodes, accessory nerve and the brachial plexus. It originates from the manubrium and medial portion of the clavicle and inserts on the mastoid process of the temporal bone, superior nuchal line. The sternocleidomastoid receives blood supply from the occipital artery and the superior thyroid artery. It is innervated by the accessory nerve (motor)and cervical plexus (sensory).
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 11
Correct
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During a surgical procedure involving the carotid artery, which nerve in the cervical plexus of nerves that is embedded in the carotid sheath is most susceptible to injury?
Your Answer: Ansa cervicalis
Explanation:The ansa cervicalis is a loop of nerves that are part of the cervical plexus. They lie superficial to the internal jugular vein in the carotid triangle. Branches from the ansa cervicalis innervate the sternohyoid, sternothyroid and the inferior belly of the omohyoid. The superior root of the ansa cervicalis is formed by a branch of spinal nerve C1. These nerve fibres travel in the hypoglossal nerve before leaving to form the superior root. The superior root goes around the occipital artery and then descends embedded in the carotid sheath. It sends a branch off to the superior belly of the omohyoid muscle and is then joined by the inferior root. The inferior root is formed by fibres from spinal nerves C2 and C3.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 12
Incorrect
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Which of the following nerves provides sensory innervation to the anteromedial and anterosuperior aspects of the external ear?
Your Answer: Auricular branch of the vagus nerve
Correct Answer: Auriculotemporal nerve
Explanation:Sensory innervation to the external ear is supplied by both cranial and spinal nerves. Branches of the trigeminal, facial, and vagus nerves (CN V, VII, X) are the cranial nerve components, while the lesser occipital (C2, C3) and greater auricular (C2, C3) nerves are the spinal nerve components involved. The lateral surface of the tympanic membrane, the external auditory canal, and the external acoustic meatus are all innervated by nervus intermedius (a branch of CN VII), the auriculotemporal nerve (CN V3), and the auricular branch of the vagus nerve. The concha receives split innervation from nervus intermedius, the auricular branch of the vagus nerve, and the greater auricular (spinal) nerve. Beyond the concha, the anteromedial and anterosuperior parts of the pinna are innervated by the auriculotemporal nerve, and a portion of the lateral helix by the lesser occipital nerve. The greater auricular nerve provides innervation to the area of the pinna inferolateral to the lobule.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 13
Incorrect
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Regarding the lacrimal apparatus, which of the following statements is CORRECT:
Your Answer: The nasolacrimal duct empties into the middle nasal meatus.
Correct Answer: Lacrimal fluid is drained from the eyeball through the lacrimal punctum.
Explanation:Lacrimal fluid is drained from the eyeball through the lacrimal punctum.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 14
Incorrect
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A 40 year old man from Japan was diagnosed with cancer of the oesophagus. He is to undergo esophagectomy. While mobilizing the oesophagus in the neck, for resection and anastomosis with the stomach tube on the left side, the surgeon must be cautious not to injure a vital structure. Which of the following is it?
Your Answer: Azygos vein
Correct Answer: Thoracic duct
Explanation:The oesophagus is divided into 3 portions: cervical (part that is in the neck), thoracic portion and the abdominal portion. The cervical part is bordered by the trachea anteriorly and the prevertebral fascia covering the bodies of the 6,7 and 8th vertebra posteriorly. The thoracic duct lies on the left side at the level of the sixth cervical vertebra. The carotid sheath with its contents and lower poles of the lateral lobes of thyroid gland are lateral. The thoracic duct is the structure most likely to be injured.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 15
Correct
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A 45-year old man presented to the emergency room with complains of chest pain and breathlessness. Upon history taking and examination, it was discovered that he had a right-sided spontaneous pneumothorax and had a failed attempt at pleural aspiration. The pneumothorax is still considerable in size, but he remains breathless. A Seldinger chest drain was inserted but it started to drain frank blood shortly after. Which of the following complications is most likely to have occurred?
Your Answer: Intercostal artery laceration
Explanation:Injury to the intercostal artery (ICA) is an infrequent but potentially life-threatening complication of all pleural interventions. Traditional anatomy teaching describes the ICA as lying in the intercostal groove, protected by the flange of the rib. This is the rationale behind the recommendation to insert needles just above the superior border of the rib. Current recommendations for chest drain insertion suggest that drains should be inserted in the ‘safe triangle’ in order to avoid the heart and the mediastinum and be above the level of the diaphragm. The safe triangle is formed anteriorly by the lateral border of the pectoralis major, laterally by the lateral border of the latissimus dorsi, inferiorly by the line of the fifth intercostal space and superiorly by the base of the axilla. Imaging guidance also aids in the safety of the procedure.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 16
Correct
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Which of the following types best describe the epithelium on the external aspect of the tympanic membrane?
Your Answer: Stratified squamous
Explanation:The external aspect of the tympanic membrane is lined by stratified squamous epithelium. Clinical correlation: Following middle ear infections, this type of epithelium can migrate into the middle ear through a perforated tympanic membrane.The ear is composed of three anatomically distinct regions: – External ear: Auricle is composed of elastic cartilage covered by skin. The lobule has no cartilage and contains fat and fibrous tissue. External auditory meatus is variable in length, measuring approximately 2.5cm long in fully grown children. Lateral third of the external auditory meatus is cartilaginous, and the medial two-thirds is bony. The greater auricular nerve innervates the region. The auriculotemporal branch of the trigeminal nerve supplies most of the external auditory meatus and the lateral surface of the auricle. – Middle ear: It is the space between the tympanic membrane and cochlea. The aditus leads to the mastoid air cells is the route through which middle ear infections may cause mastoiditis. Anteriorly the eustachian tube connects the middle ear to the nasopharynx. The tympanic membrane consists of an outer layer of stratified squamous epithelium, a middle layer of fibrous tissue and an inner layer of mucous membrane continuous with the middle ear. The chorda tympani nerve passes on the medial side of the pars flaccida. The glossopharyngeal nerve and pain innervate the middle ear. Thus, pain may radiate to the middle ear following tonsillectomy. – Ossicles:Malleus attaches to the tympanic membrane (the Umbo). Malleus articulates with the incus (synovial joint). Incus attaches to stapes (another synovial joint). – Internal ear:It consists of the cochlea, semicircular canals, and vestibule. Organ of Corti is the sense organ of hearing and is located on the inside of the cochlear duct on the basilar membrane. Vestibule accommodates the utricle and the saccule. These structures contain endolymph and are surrounded by perilymph within the vestibule. The semicircular canals lie at various angles to the petrous temporal bone. All share a common opening into the vestibule.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 17
Incorrect
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The thyrocervical trunk branches into which artery that passes upward and in front of the vertebral artery and longus colli muscle:
Your Answer: Internal thoracic
Correct Answer: Inferior thyroid
Explanation:The inferior thyroid artery is an artery in the neck. It arises from the thyrocervical trunk and passes upward, in front of the vertebral artery and longus colli muscle.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 18
Correct
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A 27-year old lady is shot in the chest. The bullet enters superior to the upper edge of the clavicle. She had difficulty in breathing which is interpreted by the A&E physician as a likely indicator of a collapsed lung. If that is the case, what portion of the pleura is most likely to have been punctured?
Your Answer: Cupola
Explanation:The cupola is part of the pleura that extends above the first rib into the root of the lung. Most likely to injured in a stab above the level of the clavicle.Costodiaphragmatic recess: the lowest extent of the pleural sac. Pulmonary ligament: is a fold of pleura located below the root of the lung. Mediastinal pleura: part of the pleura that lines the mediastinal cavity. Hilar reflection is the part of the pleura where the visceral pleura of the lung reflects to become continuous with the parietal pleura.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 19
Correct
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The otic ganglion receives its preganglionic sympathetic fibres from which of the following nerves?
Your Answer: Glossopharyngeal nerve
Explanation:The otic ganglion is a small (2–3 mm), oval shaped, flattened parasympathetic ganglion of a reddish-grey colour, located immediately below the foramen ovale in the infratemporal fossa and on the medial surface of the mandibular nerve. The preganglionic parasympathetic fibres originate in the inferior salivatory nucleus of the glossopharyngeal nerve. They leave the glossopharyngeal nerve by its tympanic branch and then pass via the tympanic plexus and the lesser petrosal nerve to the otic ganglion. Here, the fibres synapse, and the postganglionic fibres pass by communicating branches to the auriculotemporal nerve, which conveys them to the parotid gland. They produce vasodilator and secretomotor effects.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 20
Correct
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A 34 year old woman arrives at the clinic with a goitre and is diagnosed with autoimmune thyroiditis. She is most likely to develop which of the following types of cancers?
Your Answer: Lymphoma
Explanation:Pre-existing chronic autoimmune (Hashimoto’s) thyroiditis is the only known risk factor for primary thyroid lymphoma and is present in approximately one-half of patients. Among patients with Hashimoto’s thyroiditis, the risk of thyroid lymphoma is at least 60 times higher than in patients without thyroiditis.
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This question is part of the following fields:
- Head & Neck
- Pathology
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Question 21
Correct
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An elderly man presents with bilateral lower facial swelling around the mandible and upper neck. A CT scan of his neck was performed and the results were conclusive with Ludwig's angina. Which of the following spaces is most likely affected based on the case presented?
Your Answer: Submandibular space
Explanation:Ludwig’s angina is life-threatening cellulitis of the soft tissue involving the floor of the mouth and neck. It involves three compartments of the floor of the mouth: the sublingual, submental, and submandibular. Ludwig’s angina usually originates as a dental infection of the second or third mandibular molars. The infection begins in the subgingival pocket and spreads to the musculature of the floor of the mouth. It progresses below the mylohyoid line, indicating that it has moved to the sublingual space. As the roots of the second and third mandibular molars lie below this line, infection of these teeth will predispose to Ludwig’s angina. The infection spreads lingually rather than buccally because the lingual aspect of the tooth socket is thinner. It initially spreads to the sublingual space and progresses to the submandibular space. The disease is usually polymicrobial, involving oral flora, both aerobes, and anaerobes. The most common organisms are Staphylococcus, Streptococcus, Peptostreptococcus, Fusobacterium, Bacteroides, and Actinomyces.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 22
Correct
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What are some of the derivatives of the second pharyngeal arch?
Your Answer: Stylohyoid muscle
Explanation:Also known as the hyoid arch, it forms the side and front of the neck. From its cartilage develops the styloid process, stylohyoid ligament and lesser cornu of the hyoid bone. The muscular derivatives include the muscles of facial expression, stapedius, stylohyoid and the posterior belly of the digastric. All these are innervated by cranial nerve VII but migrate into the area of the mandibular arch.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 23
Correct
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A 33 year old woman complains of a persistent offensive discharge from the left ear. On examination, the hearing of left ear is found to be reduced to 40 decibels compared to the right side. Which of the following is the most likely cause of this presentation?
Your Answer: Cholesteatoma
Explanation:Cholesteatoma is a special form of chronic otitis media in which keratinizing squamous epithelium grows from the tympanic membrane or the auditory canal into the middle ear mucosa or mastoid. The presence of abnormal epithelium in an abnormal location triggers an inflammatory response that can destroy surrounding structures such as the ossicles. Cholesteatomas may be congenital or acquired later in life. Acquired cholesteatomas are usually associated with chronic middle ear infection. Cardinal symptoms are painless otorrhea and progressive hearing loss. Important diagnostic procedures include mastoid process x-rays, temporal bone CT scans, and audiometric tests. Left untreated, erosion of the surrounding bone by a cholesteatoma can lead to facial nerve palsy, extradural abscess, and/or sigmoid sinus thrombosis. Therefore, even if a cholesteatoma is asymptomatic, surgery is always indicated. Surgical treatment involves tympanomastoidectomy to excise the cholesteatoma, followed by repair of the damaged middle ear structures.
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This question is part of the following fields:
- Head & Neck
- Pathology
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Question 24
Incorrect
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The differentiation of type I and type II epithelial cells in the developing lung is evident in which gestational age?
Your Answer: Embryonic: 4-5 weeks gestation
Correct Answer: Canalicular: 16-24 weeks gestation
Explanation:The differentiation between type 1 and type 2 epithelia in the developing lung buds is evident from 16-24 weeks of gestation.Development of the respiratory tract has five stages:- Embryonic (at 4 – 5 weeks of gestation):Formation of lung buds, trachea and mainstem bronchi occur. These structures are formed from a ventral outpouching of foregut pharynx. At this stage, the beginnings of the five lung lobes are present.- Pseudoglandular (at 5 – 16 weeks of gestation):Formation of terminal bronchioles, cartilage and smooth muscles occur in this stage. – Canalicular (at 16-24 weeks gestation): Differentiation of type I and II epithelial cells can be done in this stage. There is also an increase in the size of proximal airways).- Saccular (at 24 – 40 weeks of gestation): Terminal saccule formation occurs. Production of surfactant takes place at this stage with an increase in the number of goblet cellsUp to half the adult number of alveoli are in place by this stage.- Alveolar (occurs between 32 weeks of gestation till the post-natal age 8): Formation of alveoli and septation occurs with the expansion of air spaces.
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This question is part of the following fields:
- Anatomy
- Embryology
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Question 25
Correct
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Injury of the ventral rami at this cervical spinal level will result in paralysis of the rectus capitis anterior muscle:
Your Answer: C1, C2
Explanation:The rectus capitis anterior is a short, flat muscle, situated immediately behind the upper part of the longus capitis. It is also known as the obliquus capitis superior. It aids in flexion of the head and the neck. Nerve supple is from C1 and C2.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 26
Correct
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From which branchial (pharyngeal) pouch does the inferior parathyroid gland arise?
Your Answer: 3rd
Explanation:The following structures arise from each branchial pouch: 1st pouch – eustachian tube, middle ear, mastoid, and inner layer of the tympanic membrane2nd pouch – middle ear, palatine tonsils3rd pouch – inferior parathyroid glands, thymus 4th pouch – superior parathyroid glands, ultimobranchial body which forms the parafollicular C-cells of the thyroid gland, musculature and cartilage of larynx (along with the sixth pharyngeal pouch)5th pouch – rudimentary structure6th pouch – along with the fourth pouch, contributes to the formation of the musculature and cartilage of the larynx.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 27
Correct
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Which of the following anatomical structures is most likely the cause of oedema and erythema of the arm in a patient who underwent modified radical mastectomy and radiotherapy?
Your Answer: Axillary lymph nodes
Explanation:Arm oedema is one of the sequelae after breast cancer surgery and radiation therapy. Arm oedema in the breast cancer patient is caused by interruption of the axillary lymphatic system by surgery or radiation therapy, which results in the accumulation of fluid in subcutaneous tissue in the arm, with decreased distensibility of tissue around the joints and increased weight of the extremity. Chronic inflammatory changes result in both subcutaneous and lymph vessel fibrosis.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 28
Correct
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Which of the following statements is true about percutaneous needle aspiration?
Your Answer: The needle should be inserted just above the upper border of the chosen rib
Explanation:Pleural aspiration describes a procedure whereby pleural fluid or air may be aspirated via a system inserted temporarily into the pleural space. This may be for diagnostic purposes (usually removing 20–50 ml fluid) or therapeutic to relieve symptoms. In the literature it is varyingly called thoracocentesis, thoracentesis or pleural aspiration. In determining the correct patient position and site of insertion, it is important for the operator to be aware of the normal anatomy of the thorax and the pathology of the patient. Patient position is dependent on the operator preference and the site of the pathology. In the case of a posterior lying locule, this may be specific to the image-guided spot where fluid is most likely to be obtained. In most circumstances, however, the site of insertion of the needle is either in the triangle of safety or the second intercostal space in the midclavicular line. The patient may therefore either sit upright leaning forward with arms elevated but resting on a table or bed, thereby exposing the axilla, or lying on a bed in a position. The needle is inserted in the space just above the chosen rib to avoid damaging the neurovascular bundle. It is common practice to insert the needle more posteriorly for a pleural aspiration, but it should be noted that the neurovascular bundle may not be covered by the lower flange of the rib in this position and a more lateral or anterior site of insertion is considered safer.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 29
Correct
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A 50-year-old female is undergoing a lymph node biopsy from the posterior triangle of his neck. What structure forms the posterior boundary of the posterior triangle of the neck?
Your Answer: Trapezius muscle
Explanation:The sternocleidomastoid muscle divides the neck into anterior and posterior triangles on both sides of the neck. The posterior triangle has the following boundaries: anteriorly – sternocleidomastoid muscle posteriorly – trapezius roof – investing layer of deep cervical fascia floor – prevertebral fascia overlying splenius capitis, levator scapulae, and the scalene muscles The contents of the posterior triangle are: 1. fat 2. lymph nodes (level V) 3. accessory nerve 4. cutaneous branches of the cervical plexus – greater auricular nerve, transverse cervical nerve, lesser occipital nerve, supraclavicular nerve (A major branch of this plexus is the phrenic nerve, which arises from the anterior divisions of spinal nerves C3-C5) 5. inferior belly of omohyoid 6. branches of the thyrocervical trunk (transverse cervical and suprascapular arteries) 7. third part of the subclavian artery 8. external jugular vein
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 30
Correct
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A 42 - year old male patient with an acute onset headache was brought in to the emergency department with suspicion of a subarachnoid haemorrhage (SAH). The SHO on call decided to have a diagnostic lumbar puncture after computed topography scan failed to support the suspicion. To perform a successful lumbar puncture without causing injury to the spine, which anatomical landmark should guide the SHO to locate the fourth vertebra for insertion of the spinal needle?
Your Answer: Iliac crest
Explanation:The safest spinal level for conducting a lumbar puncture, is at the level of the fourth lumbar vertebra. The anatomical landmark used to locate the fourth lumbar vertebra (L4), is the iliac crest. The needle can safely be inserted either above or below L4. The conus medullaris is at the level of the border of L1 and L2 so L4 is safely distant from it.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 31
Correct
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What is the most likely condition a new born infant is likely to suffer from, if he/she was born with incomplete fusion of the embryonic endocardial cushions?
Your Answer: An atrioventricular septal defect
Explanation:The endocardial cushions in the heart are the mesenchymal tissue that make up the part of the atrioventricular valves, atrial septum and ventricular septum. An incomplete fusion of these mesenchymal cells can cause an atrioventricular septal defect. The terms endocardial cushion defect, atrioventricular septal defect and common atrioventricular canal defect can be used interchangeably with one another.
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This question is part of the following fields:
- Anatomy
- Embryology
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Question 32
Correct
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The 'bucket handle' movement of the thoracic wall describes which of the following movements:
Your Answer: The middles of the shafts of the ribs moving upwards and laterally
Explanation:Because the middles of the shafts of the ribs are lower than either the anterior or posterior end, elevation of the ribs also moves the middles of the shafts laterally. This ‘bucket handle’ upwards and lateral movement increases the lateral dimensions of the thorax.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 33
Incorrect
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Which of the following statements about a cervical rib is correct?
Your Answer: All of the above
Correct Answer: It originates from the 7th cervical vertebra
Explanation:The costal elements of the seventh cervical vertebrae form projections known as cervical ribs, which are present in approximately 0.5% – 1 % individuals. A cervical rib commonly comprises of a head, neck and tubercle. The body of the rib varies from person to person. It extends into the posterior triangle of the neck, where it is either free anteriorly, or attached to the first rib / sternum. Patients with a cervical rib mostly are asymptomatic and it is usually diagnosed as an incidental finding on chest x-ray. However, in some cases, the subclavian artery and the lower trunk of the brachial plexus are compressed where they pass over the cervical rib. This leads to a condition known as ”neurovascular compression syndrome,” in which these neurovascular structures are compressed between the cervical rib and scalenus anterior. The most common cause of neurogenic symptoms in approximately 80% of the patients with cervical rib is neck trauma. In most cases, the tingling, numbness and impaired circulation to the upper limb appears only after puberty. This is because the neck elongates, and the shoulders droop slightly.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 34
Correct
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During thyroidectomy, the recurrent laryngeal nerves are vulnerable to injury. Which of the following muscles will not be affected in cases where the recurrent laryngeal nerve is severed?
Your Answer: Cricothyroid
Explanation:All muscles of the larynx are supplied by the recurrent laryngeal nerve except for the cricothyroid which is supplied by the vagus nerve.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 35
Incorrect
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When a patient is standing erect, pleural fluid would tend to accumulate in which part of the pleural space?
Your Answer: Costomediastinal recess
Correct Answer: Costodiaphragmatic recess
Explanation:The costo-diaphragmatic recess is the lowest extent of the pleural cavity or sac. Any fluid in the pleura will by gravity accumulate here when a patient is standing erect.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 36
Incorrect
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A textbook of cardiac surgery explains that while doing a left pneumonectomy, a surgeon must be careful to avoid injury to a vital structure that leaves an impression on the mediastinal surface of the left lung. Which structure is it referring to?
Your Answer: Inferior vena cava
Correct Answer: Aortic arch
Explanation:Structures that leave an impression on the mediastinal surface of the left lung include: the oesophagus, subclavian artery, brachiocephalic vein, first rib, thymus, the heart, the diaphragm, descending aorta and arch of the aorta. The other structures form an impression on the mediastinal aspect of the right lung.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 37
Correct
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Elevation of the eyeball is primarily produced by which of the following muscles:
Your Answer: Superior rectus and inferior oblique
Explanation:Elevation of the eyeball is produced by the superior rectus and the inferior oblique muscles.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 38
Correct
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In a neurological exam on a robbery with violence victim, it was discovered that the victim had lost sense of touch to the skin over her cheek and chin (maxilla and mandible region). Where are the cell bodies of the nerve that is responsible for touch sensations of this region located?
Your Answer: Cranial nerve V ganglion
Explanation:The skin over the cheek and the maxilla are innervated by the trigeminal nerve (CN V). The trigeminal nerve has three major branches and it is the largest cranial nerve. The three branches of the trigeminal nerve are; the ophthalmic nerve, the maxillary nerve and the mandibular nerve. The trigeminal nerves ganglion is a sensory nerve ganglion know as the trigeminal ganglion (also referred to as the Gasser’s ganglion or the semilunar ganglion). It is contained in the dura matter in a cavity known as the Meckel’s cave, which covers the trigeminal impression near the apex of the petrous part of the temporal bone.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 39
Incorrect
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In the adult heart, the sinus venosus gives rise to the:
Your Answer: Trabeculated portion of the right atrium
Correct Answer: Coronary sinus
Explanation:The sinus venosus is a large quadrangular cavity which precedes the atrium on the venous side of the chordate heart. It exists distinctly only in the embryonic heart (where it is found between the two venae cavae); however, the sinus venosus persists in the adult. In the adult, it is incorporated into the wall of the right atrium to form a smooth part called the sinus venarum, which is separated from the rest of the atrium by a ridge of fibres called the crista terminalis. The sinus venosus also forms the SA node and the coronary sinus.
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This question is part of the following fields:
- Anatomy
- Embryology
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Question 40
Incorrect
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Which pharyngeal arch is closest to the head of the embryo?
Your Answer: 2nd
Correct Answer: 1st
Explanation:The arches are numbered according to their proximity to the head i.e. the 1st is the closest to the head end of the embryo and the 6th closest to the tail end as shown by the diagram below the table
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This question is part of the following fields:
- Anatomy
- Embryology
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Question 41
Correct
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How many days after fertilisation does the morula form?
Your Answer: 4
Explanation:When there are about 12-32 blastomeres, the developing human is referred to as morula. It enters the uterine cavity around the 4th day after fertilization.
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This question is part of the following fields:
- Anatomy
- Embryology
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Question 42
Incorrect
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A 39-year-old woman, is scheduled for a thyroidectomy for her previously diagnosed Grave's disease. She is eligible for surgery as medical treatment options have failed to control her symptoms and she is the sole guardian for her young children, so radioiodine treatment is unsuitable. While gaining her consent for the surgery, she is told of possible complications of thyroidectomy, which include damage to the sensory branch of the superior laryngeal nerve. What is the name of the sensory nerve that arises from the superior laryngeal nerve?
Your Answer: Right recurrent laryngeal nerve
Correct Answer: Internal laryngeal nerve
Explanation:The superior laryngeal nerve gives off two branches: the sensory branch which is the internal laryngeal nerve, and the motor branch which is the external laryngeal nerve. The recurrent laryngeal nerve (RLN) rises from the vagus nerve which supplies the intrinsic muscles of the larynx, except the cricothyroid muscles.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 43
Correct
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The medial and lateral pterygoid muscles are innervated by which of the following nerves:
Your Answer: Mandibular division of the trigeminal nerve
Explanation:Both the medial and lateral pterygoids are innervated by the mandibular division of the trigeminal nerve.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 44
Correct
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A 25-year-old male has tonsillitis and is in considerable pain. Which nerve is responsible for the sensory innervation of the tonsillar fossa?
Your Answer: Glossopharyngeal nerve
Explanation:A tonsillar sinus or fossa is a space that is bordered by the triangular fold of the palatoglossal and palatopharyngeal arches in the lateral wall of the oral cavity. The palatine tonsils are in these sinuses. The glossopharyngeal nerve is the main sensory nerve for the tonsillar fossa. The tonsillar branches of the glossopharyngeal nerve supply the palatine tonsils forming a plexus around it. Filaments from this plexus are distributed to the soft palate and fauces where they communicate with the palatine nerves. A lesser contribution is made by the lesser palatine nerve. Because of this otalgia may occur following tonsillectomy.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 45
Incorrect
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Contraction of the diaphragm results in which of the following effects:
Your Answer: Decreased intra-abdominal pressure
Correct Answer: Increased vertical dimension of the thorax
Explanation:Contraction of the diaphragm (as in inspiration) results in flattening (depression) of the diaphragm with an increase in vertical dimension of the thorax. This results in decreased intrathoracic pressure and increased intra-abdominal pressure.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 46
Correct
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Which of the following two cerebral veins join up to form the great cerebral vein, otherwise also known as the great vein of Galen?
Your Answer: Internal cerebral veins
Explanation:The great vein of Galen or great cerebral vein, is formed by the union of the internal cerebral veins and the basal veins of Rosenthal. This vein curves upwards and backwards along the border of the splenium of the corpus callosum and eventually drains into the inferior sagittal sinus and straight sinus at its anterior extremity.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 47
Correct
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The collaborative effort of the lateral pterygoid muscles produces which action on the jaw?
Your Answer: Protrude the mandible
Explanation:The combined effort of the lateral pterygoid muscles results in the protrusion of the mandible. The lateral pterygoid muscle is a muscle of mastication located superiorly to the medial pterygoid muscle and has two heads. The superior head originates on the infratemporal surface and infratemporal crest of the greater wing of the sphenoid bone, and the inferior head on the lateral surface of the lateral pterygoid plate. The insertion of this muscle is on the front margin of the articular disc of the temporomandibular joint. The unilateral contraction of the pterygoid muscle results in the laterotrusion of the mandible. It is important to note that the lateral pterygoid muscle is the only muscle of mastication that can open the jaw.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 48
Correct
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Regarding the trachea, which of the following statements is INCORRECT:
Your Answer: A cricothyrotomy involves making an opening in the neck inferior to the cricoid cartilage.
Explanation:A cricothyrotomy involves making an opening in the median cricothyroid ligament (the medial part of the cricothyroid membrane), between the cricoid cartilage below and the thyroid cartilage above.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 49
Correct
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A 50 year-old man, who sustained a head injury experienced sudden onset of horizontal double vision. He is diagnosed with lateral rectus palsy. Which of the following nerves is affected in this condition?
Your Answer: Abducent
Explanation:The lateral rectus muscle is one of the 6 extra-ocular muscles that control eye movements. It is responsible for abduction and is the only muscle that is innervated by the abducens nerve (CN VI).
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 50
Incorrect
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Which coronary artery is mostly likely affected if an ECG shows a tombstone pattern in leads V2, V3 and V4?
Your Answer: Right coronary artery
Correct Answer: Left anterior descending artery
Explanation:Tombstoning ST elevation myocardial infarction can be described as a STEMI characterized by tombstoning ST-segment elevation. This myocardial infarction is associated with extensive myocardial damage, reduced left ventricle function, serious hospital complications and poor prognosis. Tombstoning ECG pattern is a notion beyond morphological difference and is associated with more serious clinical results. Studies have shown that tombstoning is more commonly found in anterior than non-anterior STEMI, thus, higher rates of left anterior descending artery disease are observed in patients with tombstoning pattern. The following ECG leads determine the location and vessels involved in myocardial infarction: ECG Leads Location Vessel involved V1-V2 Septal wall Left anterior descending V3-V4 Anterior wall Left anterior descending V5-V6 Lateral wall Left circumflex artery II, III, aVF Inferior wall Right coronary artery (80%) or Left circumflex artery (20%) I, aVL High lateral wall Left circumflex artery V1, V4R Right ventricle Right coronary artery V7-V9 Posterior wall Right coronary artery
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This question is part of the following fields:
- Anatomy
- Thorax
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SESSION STATS - PERFORMANCE PER SPECIALTY
