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Contents:

TESTS 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, ANATOMY ANAESTHESIA MONITORING CARDIORESPIRATORY PHYSIOLOGY CLINICAL INVESTIGATION GENERAL ANAESTHESIA OPIATES AND OTHERS MEDICINE ECHOCARDIOGRAPHY OBSTETRIC ANAESTHESIA PEDIATRIC ANAESTHESIA PERFUSION PHARMACOLOGY OTHER PHYSIOLOGY REGIONAL AND SPECIALTY RELAXANT AND LOCAL ANAESTHETICS RENAL AND NEUROPHYSIOLOGY STATISTICS SURGERY TRAUMA TRIVIAL PURSUITS X-RAY ECG GENERAL PRIMARY MCQS MCQS A-K MCQ PAPERS PHYSIOLOGY MCQS PHARMACOLOGY MCQS pgs :3-66 pgs: 66-129 pgs: 130-160 pgs: 160-173 pgs: 174-260 pgs. 260-309 pgs: 309-395 pgs: 396-401 pgs: 402-426 pgs: 426-450 pgs: 450-471 pgs: 471-492 pgs: 492-499 pgs: 499-564 pgs: 564-595 pgs: 595-607 pgs: 607-617 pgs: 617-642 pgs: 642-660 pgs: 661-677 pgs: 677-689 pgs: 690-706 pgs: 707-776 pgs: 776-859 pgs: 859-900 pgs: 901-922 pgs: 922-937

ORAL QUESTIONS 28, 29, OSCE AND VIVA QUESTIONS FINAL FRCA QUESTIONS pgs: 937-1020 pgs: 1020-1064

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ANATOMY TESTS Number: 84 In adults, the angle at which the right main bronchus leaves the carina is: A. 15 degrees. B. 20 degrees. C. 25 degrees. D. 30 degrees. E. 35 degrees. Select the single best answer ABCDE Correct Answer: C In adults, the angle between the left and right main bronchi and the midline are 45 and 25 degrees respectively. In infants, these are 47 and 30 degrees. LATTO, I.P & ROSEN, M. (EDS); Difficulties in Tracheal Intubation, Balliere Tindall, pp 910. Number: 134 Which of the following are true of a cervical rib? A. It occurs commonly. B. It is apparent on palpation in the supraclavicular region. C. It originates from the 7th cervical vertebra. D. It commonly causes compression of the subclavian artery and brachial plexus. E. All of the above. Select the single best answer ABCDE Correct Answer: C In 0.5-1% of individuals, the costal elements of the 7th cervical vertebra form projections called cervical ribs. Commonly they have a head, neck, and tubercle, with varying amounts of body. They extend into the posterior triangle of the neck where they may be free anteriorly, or be attached to the first rib and/or sternum. Usually these ribs cause no symptoms, and are diagnosed after incidental finding on CXR. In some cases, the subclavian artery and the lower trunk of the brachial plexus are kinked where they pass over the cervical rib. Compression of these structures between this extra rib and the anterior scalene muscle may produce symptoms of nerve and arterial compression, producing the "neurovascular compression syndrome".

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Often the tingling, numbness, and impaired circulation to the upper limb do not appear until the age of puberty when the neck elongates and the shoulders tend to droop slightly. MOORE, K.L.; Clinically Oriented Anatomy, Williams and Wilkins, 1980, pp 701. Number: 135 With respect to the intercostal nerves: 1. They represent the dorsal rami of the thoracic spinal nerves. 2. The twelfth intercostal nerve is also known as the subcostal nerve. 3. Anteriorly they run in the costal groove on the upper margin of the rib. 4. Each is connected to a ganglion of the sympathetic trunk. A: 1,2,3 Correct B: 1,3 Correct C: 2,4 Correct D: 4 Correct E: All Correct ABCDE Correct Answer: C The intercostal nerves represent the ventral rami of the first 11 thoracic spinal nerves. The twelfth, being below the 12th rib is subcostal, hence is called the subcostal nerve. Each intercostal nerve is connected to a ganglion of the sympathetic trunk by rami communicantes to and from which it carries preganglionic and postganglionic fibres which innervate blood vessels, sweat glands, and muscles. The 3rd to 6th intercostal nerves behave typically. A typical nerve enters the intercostal space between the parietal pleura and internal intercostal membrane and muscle. At first it runs along the middle of the intercostal space, then at the angle of the rib, it passes between the internal and innermost intercostal muscles (which begins here). Here it enters the costal groove on the inferior margin of the rib, where it runs with the intercostal vessels. It continues forward giving off several branches and terminates about 1 cm from the sternum as an anterior cutaneous branch. The branches comprise: (1) A collateral branch which arises near the angle of the rib and runs along the upper margin of the rib below to supply the intercostal muscles. (2) A lateral cutaneous branch which arises beyond the angle of the rib and pierces the internal and external intercostal muscles about halfway around the thorax. The cutaneous branches divide into anterior and posterior branches which supply the skin of the thoracic and abdominal walls. (3) Muscular branches supply the subcostal, transversus thoracis, levator costae, and serratus posterior muscles. Note that the intercostal nerves do not supply the muscles connecting the pectoral muscles, trapezius, lattisimus dorsi, rhomboids, or levator scapulae. These muscles are supplied by the accessory nerve and the cervical and brachial plexuses.

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The other intercostal nerves have some individual characteristics. (1)The first intercostal nerve usually has no lateral cutaneous branch. It divides into a large upper and small lower part. The upper part joins the brachial plexus; the lower part becomes the 1st intercostal nerve. (2) The second intercostal nerve may also contribute a small branch to the brachial plexus. Its lateral cutaneous branch is called the intercostobrachial nerve which supplies sensory innervation to the floor of the axilla and communicates with the medial cutaneous nerve of the arm to supply the medial aspect of the arm as far as the elbow. (3) The 7th to 11th intercostal nerves supply the abdominal as well as the thoracic wall. References MOORE, K.L.; Clinically Oriented Anatomy, Williams and Wilkins, 1980, pp 29-30. Number: 136 The musculocutaneous nerve: A. Is a branch of the lateral cord of the brachial plexus. B. Leaves the plexus at the point at which it crosses the first rib. C. Receives fibres from the 8th cervical spinal root. D. Only contains sensory fibres. E. None of the above. Select the single best answer ABCDE Correct Answer: A The musculocutaneous nerve is the major terminal branch of the lateral cord of the brachial plexus. The lateral cord contains fibres from the superior and middle trunks which represent the spinal roots of the 5th to 7th cervical vertebrae. It leaves the plexus as the cords give off their branches to the major nerves of the arm. The cords correspond to the point at which the plexus emerges from behind the clavicle. It courses the axilla in the coracobrachialis muscle, and then descends obliquely and laterally between the biceps and brachialis muscles, sending motor fibres to all of these. It terminates in the forearm as the lateral antebrachial cutaneous nerve supplying sensation to the lateral aspect of the forearm. WINNIE, A.P.; Plexus Anesthesia, vol 1, Churchill Livingstone, 1984, p 224 & pp 16-28. Number: 137 Which of the following are branches of the brachial plexus? 1. Lateral pectoral nerve. 2. Medial pectoral nerve. 3. Medial brachial cutaneous nerve. 4. The intercostobrachial nerve.

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A: 1,2,3 Correct B: 1,3 Correct C: 2,4 Correct D: 4 Correct E: All Correct ABCDE Correct Answer: A The intercostobrachial nerve represents the lateral cutaneous branch of the second intercostal nerve. It forms a loop and runs with the medial brachial cutaneous nerve, together supplying sensory innervation of the medial aspect of the arm as far as the elbow. All the others represent infraclavicular branches of the brachial plexus. WINNIE, A.P.; Plexus Anesthesia, vol 1, Churchill Livingstone, 1984, pp 19-42.

Which of the following structures accompany the median nerve in the carpal tunnel? A. Flexor carpi ulnaris. B. Flexor digitorum profundis. C. The ulnar artery. D. All of the above. E. None of the above. Select the single best answer ABCDE Correct Answer: B The carpal tunnel is an osseofibrous tunnel formed by the flexor retinaculum in the wrist. The median nerve and tendons of the long flexor muscles of the digits pass through it. MOORE, K.L.; Clinically Oriented Anatomy, Williams and Wilkins, 1980, p 767. Number: 139 Transection of the facial nerve as it passes through the facial canal will be evidenced by: 1. Inability to wink the eye. 2. Inability to whistle. 3. Dribbling. 4. Inability to raise the eyebrows.

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A: 1,2,3 Correct B: 1,3 Correct C: 2,4 Correct D: 4 Correct E: All Correct ABCDE Correct Answer: A All the muscles of facial expression are supplied by the facial nerve. The frontalis is part of the a scalp muscle called the occipito-frontalis. It elevates the eyebrows. This muscle receives part of its innervation from the contralateral motor cortex and preservation of this manoeuvre in the presence of ipsilateral facial weakness is suggestive of an upper motor neuron lesion occurring in the motor cortex or internal capsule, before the contralateral fibres join the ipsilateral fibres and become the facial nerve. The facial nerve also innervates the buccinator, hence difficulty chewing, whistling, and withholding dribble may occur. MOORE, K.L.; Clinically Oriented Anatomy, Williams and Wilkins, 1980, pp 878-82. Number: 139 Transection of the facial nerve as it passes through the facial canal will be evidenced by: 1. Inability to wink the eye. 2. Inability to whistle. 3. Dribbling. 4. Inability to raise the eyebrows. A: 1,2,3 Correct B: 1,3 Correct C: 2,4 Correct D: 4 Correct E: All Correct ABCDE Correct Answer: A All the muscles of facial expression are supplied by the facial nerve. The frontalis is part of the a scalp muscle called the occipito-frontalis. It elevates the eyebrows. This muscle receives part of its innervation from the contralateral motor cortex and preservation of this manoeuvre in the presence of ipsilateral facial weakness is suggestive of an upper motor neuron lesion occurring in the motor cortex or internal capsule, before the contralateral fibres join the ipsilateral fibres and become the facial nerve. The facial nerve also innervates the buccinator, hence difficulty chewing, whistling, and withholding dribble may occur.

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MOORE, K.L.; Clinically Oriented Anatomy, Williams and Wilkins, 1980, pp 878-82. Number: 141 Which of the following structures pass through the foramen magnum? 1. The vertebral arteries. 2. The glossopharyngeal nerves. 3. Spinal arteries supplying the upper portion of the spinal cord. 4. The vagi. A: 1,2,3 Correct B: 1,3 Correct C: 2,4 Correct D: 4 Correct E: All Correct ABCDE Correct Answer: B The structures passing through the foramen magnum are: (1)The spinal cord- the junction of the spinal cord and medulla of the brainstem. (2)The spinal roots of the accessory nerves (cranial nerves IX) (3)The meningeal branches of the upper cervical nerves (C1to C3) (4)The meninges (5)The vertebral arteries ascending to supply parts of the brain (6)The anterior and posterior spinal arteries descending to supply the upper part of the spinal cord. Four other foramina exist in the posterior cranial fossa. These are the jugular foramen, the hypoglossal canal, the condylar canal, and the internal acoustic meatus. The contents of the jugular foramen are: (1)The superior bulb of the internal jugular vein. The sigmoid sinus enters into this. The jugular glomus is a small ovoid body consisting of chemoreceptor tissue which is enclosed in the adventitia of the jugular bulb. (2)The glossopharyngeal nerve (3)The vagus (4)The accessory nerve (5)The inferior petrosal sinus on its way to the upper end of the internal jugular vein. References MOORE, K.L.; Clinically Oriented Anatomy, Williams and Wilkins, 1980, pp 911-13.

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Number: 141 Which of the following structures pass through the foramen magnum? 1. The vertebral arteries. 2. The glossopharyngeal nerves. 3. Spinal arteries supplying the upper portion of the spinal cord. 4. The vagi. A: 1,2,3 Correct B: 1,3 Correct C: 2,4 Correct D: 4 Correct E: All Correct ABCDE Correct Answer: B The structures passing through the foramen magnum are: (1)The spinal cord- the junction of the spinal cord and medulla of the brainstem. (2)The spinal roots of the accessory nerves (cranial nerves IX) (3)The meningeal branches of the upper cervical nerves (C1to C3) (4)The meninges (5)The vertebral arteries ascending to supply parts of the brain (6)The anterior and posterior spinal arteries descending to supply the upper part of the spinal cord. Four other foramina exist in the posterior cranial fossa. These are the jugular foramen, the hypoglossal canal, the condylar canal, and the internal acoustic meatus. The contents of the jugular foramen are: (1)The superior bulb of the internal jugular vein. The sigmoid sinus enters into this. The jugular glomus is a small ovoid body consisting of chemoreceptor tissue which is enclosed in the adventitia of the jugular bulb. (2)The glossopharyngeal nerve (3)The vagus (4)The accessory nerve (5)The inferior petrosal sinus on its way to the upper end of the internal jugular vein. References MOORE, K.L.; Clinically Oriented Anatomy, Williams and Wilkins, 1980, pp 911-13.

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Number: 142 Which of the following are true statements concerning the blood supply of the spinal cord via the anterior spinal artery? A. A single pair of arteries supply the anterior region for the entire length of the cord. B. No collateral blood supply exists. C. Thrombosis results in paraplegia and paraesthesia. D. All of the above. E. None of the above. Select the single best answer ABCDE Correct Answer: E The anterior spinal artery is a single vessel lying in the pia mater in front of the anterior median fissure. It arises from the junction of two small arteries which are branches of each vertebral arteries at the level of the foramen magnum. It descends along the entire length of the spinal cord, receiving small communications from the intercostal and lumbar arteries. To provide the extra blood supply needed in the thoracic and lumbar enlargements, the communicating branches at the level of T1 and T2 are larger than the others (the arteries of Adamkiewicz). Thrombosis of the anterior spinal artery results in the syndrome in which there is paraplegia without involvement of the modalities subserved by the posterior columns: joint position, touch, and vibration sense. The posterior spinal arteries are two or three in number on each side and originate in the posterior inferior cerebellar arteries at the base of the brain. They supply the posterior columns of the cord. There are no anastomoses between the anterior and posterior arteries: in fact, the vascularization of the cord comprises three distinct territories- one anterior, and two posterior. LEE, J.A. ET AL; Sir Robert Macintosh's Lumbar Puncture and Spinal Analgesia, 5th Ed., Churchill Livingstone, 1985, p 53. Number: 143 A palsy of the third cranial nerve will result in which apparent gaze of the eyeball? A. Inferolaterally. B. Inferomedially. C. Superolaterally. D. Superomedially. E. Laterally. Select the single best answer

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ABCDE Correct Answer: A The cranial nerves, CN III (oculomotor), IV (trochlear), and VI (abducens) supply the muscles of the orbit. They enter the orbit through the superior orbital fissure. CN IV supplies the superior oblique which rotates the eyeball in an inferolateral direction; CN VI supplies the lateral rectus which abducts the eye; and CN III supplies the levator palpebrae superioris which elevate the eyelid, and the medial , superior, and inferior rectus muscles, which rotate the eyeball in the same direction. A palsy of CN III will result in the unopposed action of CN IV and VI. The eye will appear to gaze "down and out". MOORE, K.L.; Clinically Oriented Anatomy, Williams and Wilkins, 1980, p 970. Number: 144 Which of the following structures would be encountered if a needle were passed directly back at a site two fingerbreadths medial and inferior to the anterior superior iliac spine? 1. The aponeurosis of the external oblique muscle. 2. The transversalis fascia. 3. Scarpa's fascia. 4. Camper's fascia. A: 1,2,3 Correct B: 1,3 Correct C: 2,4 Correct D: 4 Correct E: All Correct ABCDE Correct Answer: E The fascia of the anterior abdominal wall is divided into superficial and deep. The superficial fascia consists of a fatty superficial layer (Camper's fascia) and membranous deeper layer (Scarpa's fascia). The deep fascia forms a layer over the external oblique muscle. The transversalis fascia lines the entire abdominal wall. It covers the deep surface of the transversalis muscle and its aponeurosis. MOORE, K.L.; Clinically Oriented Anatomy, Williams and Wilkins, 1980, pp 127-9.

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Number: 145 A needle inserted directly backwards into the sacral hiatus: 1. Will penetrate the sacro-coccygeal ligament. 2. Will encounter the 3rd sacral vertebral segment. 3. Is likely to remain extradurally. 4. Is at the level of the posterior superior iliac spines. A: 1,2,3 Correct B: 1,3 Correct C: 2,4 Correct D: 4 Correct E: All Correct ABCDE Correct Answer: B The sacral hiatus is formed by the failure of fusion of the 5th and often the 4th vertebral laminae. It is covered by the sacro-coccygeal ligament. The sacral canal ends at the sacral hiatus. It follows the curve of the sacrum and in cross section is triangular. In the average adult, the dural sac extends to the lower border of the 2nd sacral vertebra which is at the level of the posterior superior iliac spines. This discrepancy between the dural sac and the sacral canal is exploited in caudal anaesthesia. The filum terminale extends from the cord, through the dura to the coccygeal periosteum. The canal contains in addition to the dural sac, the sacral nerves, loose fat, veins, and the filum terminale. LEE, J.A. ET AL; Sir Robert Macintosh's, Lumbar Puncture and Spinal Analgesia, 5th Ed., Churchill Livingstone, 1985, p 66. Number: 146 Which of the following arteries form part of the "circle of Willis"? 1. Anterior communicating artery. 2. Posterior communicating arteries. 3. Internal carotid artery. 4. Basilar arteries. A: 1,2,3 Correct B: 1,3 Correct C: 2,4 Correct D: 4 Correct E: All Correct ABCDE

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Correct Answer: E The " circle of Willis " is formed at the base of the brain and represents the fusion of the four major arterial systems supplying the brain: the internal carotid arteries, and the vertebral arteries. It is formed by the anterior communicating artery, the anterior cerebral, a short segment of each internal carotid, the posterior communicating, the posterior cerebral and the basilar arteries. The middle cerebral artery is a continuation of the internal carotid artery and is not part of the circle. MOORE, K.L.; Clinically Oriented Anatomy, Williams and Wilkins, 1980, pp 949-50. Number: 147 Which of the following are contained within the carotid sheath? 1. The common carotid artery. 2. The external carotid artery. 3. The internal carotid artery. 4. The sympathetic trunk. A: 1,2,3 Correct B: 1,3 Correct C: 2,4 Correct D: 4 Correct E: All Correct ABCDE Correct Answer: B The carotid sheath is a tubular, fascial condensation that extends from the base of the skull to the root of the neck. It is formed by the fascial extensions of the cervical fascia, and its fibres fuse with the prevertebral fascia. It contains several structures: 1. The common and internal carotid arteries. 2. The internal jugular vein. 3. The vagus nerve. 4. The superior root of the ansa cervicalis is sometimes embedded within the carotid sheath. 5. Deep cervical lymph nodes. The cervical part of the sympathetic trunk runs posterior to the sheath. MOORE, K.L.; Clinically Oriented Anatomy, Williams and Wilkins, 1980, p 1128.

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Number: 148 Which of the following statements are true? A. The most prominent spinous process palpable represents T1. B. The tip of the spine of T9 is opposite the inferior angle of the scapula. C. The dimples overlying the posterior superior iliac spines are on a line crossing the termination of the dural sac in the spinal canal at S2. D. The lower end of the spinal cord is opposite the lower border of the body of L2 and sometimes extends a little below this. E. All of the above. Select the single best answer ABCDE Correct Answer: C The spinous process of C7 (vertebra prominens) is generally easily palpated and represents the most prominent spinous process. The tip of the spine of T7 is opposite the inferior angle of the scapula when the arms are held by the side. The lower end of the spinal cord is opposite the lower border of the body of L1 and sometimes extends a little below this. LEE, J.A. ET AL; Sir Robert Macintosh's, Lumbar Puncture and Spinal Analgesia, 5th Ed., Churchill Livingstone, 1985, p 38. Number: 149 With respect to the extradural space: 1. The spinal dura mater is loosely attached to the foramen magnum and permits some spread of local anaesthetic agent cephalad during a "high" extradural block. 2. It terminates with the filum terminale at the lower border of the second sacral vertebra. 3. It is of uniform width from the anterior to posterior compartments. 4. The extradural veins mainly occupy the antero-lateral compartment. A: 1,2,3 Correct B: 1,3 Correct C: 2,4 Correct D: 4 Correct E: All Correct ABCDE Correct Answer: D

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The dura mater, although continuous, can be described in two parts, cranial and spinal. The cranial dura mater consists of two layers, endosteal and meningeal (opponents of this view state that the endosteal layer is actually the inner periosteal lining), closely united except where they enclose the great venous sinuses which drain the blood from the brain. At the foramen magnum, the endosteal layer is reflected back to become continuous with the periosteum on the outer surface of the bone. In the vertebral canal, it is represented by the periosteal lining of the vertebrae. The meningeal layer invests the brain and folds inwards to form the tentorium cerebelli and falx cerebri. In the vertebral canal, the spinal dura mater represents the downward continuation of the meningeal layer of the cranial dura mater. It is firmly attached around the circumference of the foramen magnum. The spread of methylene blue injected into the extradural space has been observed. The upward spread is limited by the attachment of the spinal dura mater to the foramen magnum. The spinal dura mater invests the spinal cord forming a "dural sac" between itself and the arachnoid mater. The dura mater and its sac terminate at the lower border of the second sacral spinal vertebra. The potential space which is the extradural space extends with the filum terminale caudad to this; the lowermost point of the extradural space occurs at the sacral hiatus and the filum terminale inserts into the periosteum at the back of the coccyx. This discrepancy is exploited in caudal anaesthesia. The width of the extradural space largely depends upon the amount of fat contained at any site. This is greatest in the median plane posteriorly where the summit of the vertebral arch is commonly separated from the rounded posterior aspect of the dura by 5-6 mm, and anterolaterally where it is continuous with the pads of fat surrounding the spinal nerves in the intervertebral foramina. Between the posterior-lateral walls of the lumbar vertebral canal and the dura, the space is narrower, and the fat is less evident. Anteriorly, in a thin subject, the space is only potential, since here the dura lies close to the posterior longitudinal ligament on the posterior aspects of the vertebral bodies The extradural veins form a plexus which is most dense in the antero-lateral compartment. LEE, J.A. ET AL; Sir Robert Macintosh's, Lumbar Puncture and Spinal Analgesia, 5th Ed., Churchill Livingstone, 1985, pp 53-60. Number: 150 The depth of the subarachnoid space in the thoracic region is: A. 1 mm. B. 3 mm. C. 5 mm. D. 9 mm. E. 12 mm. Select the single best answer ABCDE Correct Answer: B

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In the cervical and thoracic regions of the spinal cord. the subarachnoid space is annular and has a depth of only 3 mm between the arachnoid mater and the pia mater which is adherent to the spinal cord. The spinal cord terminates at the lower border of L1 (or upper border of L2 in some texts). At this point, the subarachnoid space becomes circular and has a diameter of approximately 15 mm. LEE, J.A. ET AL; Sir Robert Macintosh's, Lumbar Puncture and Spinal Analgesia, 5th Ed., Churchill Livingstone, 1985, p 60 Number: 151 In a neonate, the spinal cord terminates at the lower border of: A. T12. B. L1. C. L2. D. L3. E. L4. Select the single best answer ABCDE Correct Answer: D In early foetal life, the spinal cord is as long as the vertebral canal. During development, however, increase in the length of the cord does not keep pace with the growth of the vertebrae. At birth the tip of the spinal cord has risen from the level of the second coccygeal vertebra to the lower border of the third lumbar vertebra. LEE, J.A ET AL; Sir Robert Macintosh's, Lumbar Puncture and Spinal Analgesia, 5th Ed., Churchill Livingstone, 1985, p 64. Number: 152 Which of the following statements concerning the innervation of the abdomen by the autonomic nervous system are true? 1. Afferents accompanying sympathetic fibres enter the spinal cord between T5 and L1. 2. All splanchnic sympathetic nerves pierce the crura of the diaphragm. 3. The coeliac plexus receives sympathetic and parasympathetic fibres. 4. Afferent impulses accompanying parasympathetic fibres cannot be abolished by a block to T5. A: 1,2,3 Correct B: 1,3 Correct C: 2,4 Correct D: 4 Correct

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E: All Correct ABCDE Correct Answer: E The visceral motor nerve supply to the abdominal and pelvic organs are derived from both sympathetic and parasympathetic components of the autonomic nervous system. Sympathetic preganglionic fibres leave the spinal cord between the levels of T5 and L1 or L2. After leaving the paravertebral ganglia they fuse to form three splanchnic nerves on each side. These enter the abdomen by piercing the crura of the diaphragm and end in the coeliac plexus and the other pre-aortic plexuses from which they reach the viscera with the arterial supply. Visceral afferent impulses from the abdomen travel along fibres which accompany the efferent sympathetic fibres, pass through the paravertebral sympathetic ganglia and proceed up the splanchnic nerves to enter the spinal nerves. They enter the spinal cord via the dorsal root ganglia between T5 and L2. The visceral parasympathetic nerves leave the central nervous system in two distinct parts; cranial and sacral. That section of the cranial parasympathetic outflow which supplies the viscera consists of fibres in the vagus nerves which run their course outside the vertebral canal to enter the abdomen, passing through a hole in the diaphragm with the oesophagus at the level of the 10th thoracic vertebra. Here they innervate the stomach, and communicate freely with the coeliac plexus through which they are distributed to the rest of the alimentary canal up to the distal part of the transverse colon. Afferent impulses accompany the vagi as evidenced the inability to abolish "visceral" type sensation with a block of spinal segments to T5. LEE, J.A .ET AL; Sir Robert Macintosh's, Lumbar Puncture and Spinal Analgesia, 5th Ed., Churchill Livingstone, 1985, p 78-9. Number: 153 Which cranial nerves contribute to the sensory innervation of the tongue? 1. V. 2. VII. 3. IX. 4. XII. A: 1,2,3 Correct B: 1,3 Correct C: 2,4 Correct D: 4 Correct E: All Correct ABCDE Correct Answer: A

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Sensation to the anterior two thirds of the tongue is supplied by the lingual branch of the mandibular nerve, the third division of the trigeminal nerve (CN V). This nerve also carries the taste fibres of the chorda tympani branch of the facial nerve (CN VII). Common sensation and taste to the posterior one third of the tongue is supplied by the glossopharyngeal nerve (CN IX). A few fibres of the superior laryngeal branch of the vagus (CN X) also supply sensation to this area. The hypoglossal nerve (CN XII) provides motor innervation to all the muscles of the tongue except palatoglossus which is innervated by CN XI via the pharyngeal plexus. MORRIS, I.R; " Functional Anatomy of the Airway ", Emergency Medicine Clinics of North America, vol 6, no 4, Nov. 1988, p 650. Number: 154 The cricoid cartilage in an infant is located at the level of which cervical vertebra? A. C1. B. C2. C. C3. D. C4. E. C5. Select the single best answer ABCDE Correct Answer: D In infants, the glottis is located two to three segments higher than in adults. The cricoid cartilage in infants is at the level of C4 as opposed to C6 in adults. ROGERS, M.C. ET AL (EDS); Principles and Practice of Anesthesiology, Mosby, 1993, p 442. Number: 155 Which of the following structures are contained within the posterior mediastinum? 1. The thoracic duct. 2. Oesophagus. 3. Azygos vein. 4. The thymus gland. A: 1,2,3 Correct B: 1,3 Correct C: 2,4 Correct D: 4 Correct E: All Correct

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ABCDE Correct Answer: A The posterior mediastinum is the part of the mediastinum located posterior to the fibrous pericardium, below the fourth thoracic vertebra. Its lower part lies at a lower level than the anterior part of the diaphragm, but at the level of the diaphragm posteriorly. It contains the thoracic aorta, oesophagus, thoracic duct, azygos and hemiazygos veins, posterior intercostal arteries and some intercostal veins. The thymus gland is contained in the superior mediastinum. References MOORE, K.L.; Clinically Oriented Anatomy, Williams and Wilkins, 1980, p 99. Number: 156 The oesophagus: A. Extends for 1.5 cm below the diaphragm. B. Pierces the diaphragm to the left of the midline. C. Forms a groove in the left lobe of the liver. D. All of the above. E. None of the above. Select the single best answer ABCDE Correct Answer: D The oesophagus pierces the diaphragm just to the left of the midline and extends for 1.5 cm intraabdominally before joining the stomach. It forms a groove on the surface of the left lobe of the liver before joining the stomach. References MOORE, K.L.; Clinically Oriented Anatomy, Williams and Wilkins, 1980, pp 158-9. Number: 185 The internal jugular vein: 1. Is lateral to the carotid artery at the level of the cricoid cartilage. 2. Is postero-lateral to the carotid artery at the base of the skull. 3. Is anterior to the carotid artery at the base of the neck. 4. Lies outside the carotid sheath.

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A: 1,2,3 Correct B: 1,3 Correct C: 2,4 Correct D: 4 Correct E: All Correct ABCDE Correct Answer: A Emerging from the base of the skull through the jugular foramen, the internal jugular vein enters the carotid sheath dorsally to the internal carotid artery (CA). Initially, it runs posterolateral to the internal, then the common carotid artery, beneath the sternocleidomastoid muscle. As it approaches the base of the neck, its relationship with the CA becomes lateral, and then anterior. References ROHEN, J.W. & YOKOCHI; Color Atlas of Anatomy, Igaku-Shoin, 1988 . Number: 209 In this Left Anterior Oblique view of the heart, the artery indicated by the figure "2" is: A. Left Anterior Descending. B. 1st Diagonal C. Obtuse Marginal D. Circumflex E. Septal Select the single best answer

ABCDE

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Correct Answer: B 1. Left Anterior Descending. 2. 1st Diagonal 3. Obtuse Marginal 4. Circumflex

Number: 214 A patient who has suffered a penetrating wound above the clavicle and who has evidence of degeneration in the axillary, musculocutaneous and long thoracic nerves will may have severed which ventral ramus? A. C4 B. C6 C. C8 D. T1 E. None of the above. Select the single best answer ABCDE Correct Answer: B Number: 215 Which nerve usually accompanies the external jugular vein as it crosses the surface of the sternocleidomastoid muscle. A. Spinal accessory. B. Great auricular. C. Lesser occipital. D. Greater occipital. D. All of the above. Select the single best answer ABCDE Correct Answer: B The great auricular nerve winds around the posterior border of the sternomastoid (where it is occasionally palpable as a small nodules) and ascends obliquely across that muscle onto the parotid gland, where it divides to supply the skin over the gland and over the mastoid process, together with both surfaces of the auricle.

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Number: 216 Which nerve constitutes the afferent (sensory) supply to the piriform fossa? A. Glossopharyngeal (IX) B. External laryngeal C. Internal laryngeal D. Hypoglossal (XII) E. Recurrent Laryngeal Select the single best answer ABCDE Correct Answer: C The internal laryngeal nerve, is afferent from the mucous membrane of the larynx. The area of mucosa supplied extends from the epiglottis and the back of the tongue down to the vocal folds. Simulation of the internal laryngeal nerve results in sensations of touch and pain. The nerve pierces the thyrohyoid membrane above the superior laryngeal artery and divides into terminal branches. A twig is given to the transverse arytenoid muscle, but whether these fibers are motor or proprioceptive is disputed). The internal laryngeal nerve ends by joining branches of the recurrent laryngeal nerve. The anastomosis may take place behind or in the substance of the posterior crico-arytenoid and the connection may pierce the inferior constrictor of the pharynx. Number: 216 Which nerve constitutes the afferent (sensory) supply to the piriform fossa? A. Glossopharyngeal (IX) B. External laryngeal C. Internal laryngeal D. Hypoglossal (XII) E. Recurrent Laryngeal Select the single best answer ABCDE Correct Answer: C The internal laryngeal nerve, is afferent from the mucous membrane of the larynx. The area of mucosa supplied extends from the epiglottis and the back of the tongue down to the vocal folds. Simulation of the internal laryngeal nerve results in sensations of touch and pain. The nerve pierces the thyrohyoid membrane above the superior laryngeal artery and divides into terminal branches. A twig is given to the transverse arytenoid muscle, but whether these fibers are motor or proprioceptive is disputed). The internal laryngeal nerve ends by joining branches of the recurrent laryngeal nerve. The anastomosis may take place behind or in the substance of the posterior crico-arytenoid and the connection may pierce the inferior constrictor of the pharynx.

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Number: 218 The dorsal scapular nerve innervates: A. trapezius B. levator scapulae C. latissimus dorsi D. splenius cervicis E. None of the above Select the single best answer ABCDE Correct Answer: B The dorsal scapular nerve (Nerve to the rhomboids) arises mainly from C5, pierces scalenus medius, runs deep to levator scapulae (which it usually supplies) and finally enters the deep surface of the rhomboids. Levatot scapulae may also be supplied directly from C3 and C4 by superficial branches. Number: 219 The nerve which is most closely associated with the radial artery in the forearm is the : A. Median nerve. B. Superficial radial nerve. C. Deep radial nerve. D. Anterior interosseous nerve. E. None of the above. Select the single best answer ABCDE Correct Answer: B

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Number: 220 Which nerve accompanies the deep palmar arch? A. Deep branch of the radial nerve B. Superficial branch of the radial nerve C. Deep branch of the ulnar nerve D. Superficial branch of the ulnar nerve E. None of the above. Select the single best answer ABCDE Correct Answer: C Number: 225 Hilton's law, applied to the knee joint, would predict innervation of the joint by: 1. The femoral nerve 2. The tibial nerve 3. The obturator nerve 4. The Common Peroneal nerve A: 1,2,3 Correct B: 1,3 Correct C: 2,4 Correct D: 4 Correct E: All Correct ABCDE Correct Answer: A Hilton's law states that the innervation of a joint is by all nerves which supply muscles which act across the same joint. Number: 234 Which nerve root, if compressed by a herniated disc, would result in a diminished knee jerk? A. L1 B. L2 C. L3 D. L4 E. L5 Select the single best answer

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ABCDE Correct Answer: D L4 nerve root compression results a diminished knee jerk. Number: 273 The thyroid gland: 1. Has C cells that are derived from the ultimobranchial body 2. Is at the level of the fifth to seventh cervical and first thoracic vertebrae 3. May have accessory nodules in the tongue 4. Develops from the endoderm between the second and third pharyngeal pouches A: 1,2,3 Correct B: 1,3 Correct C: 2,4 Correct D: 4 Correct E: All Correct ABCDE Correct Answer: A It develops from the endoderm between the first and second pharyngeal pouches. Number: 275 Which of the following statements about the anatomy of the coronary arteries are correct: 1. Tthe anterior two thirds of the interventricular septum are supllied by the anterior descending artery 2. The atrioventricular node is typically supplied by the right coronary artery 3. The circumflex artery runs in the left atrioventricular groove 4. The left coronary artery arises from the anterior aortic sinus A: 1,2,3 Correct B: 1,3 Correct C: 2,4 Correct D: 4 Correct E: All Correct ABCDE Correct Answer: A

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The right coronary artery arises from the anterior aortic sinus. Number: 299 The corticospinal tract: 1. Runs on the anterior aspect of the medulla. 2. Originates predominantly from the cortical cells of the precentral gyrus. 3. Runs in the pyramid. 4. Decussates in the midbrain. A: 1,2,3 Correct B: 1,3 Correct C: 2,4 Correct D: 4 Correct E: All Correct ABCDE Correct Answer: A The decussation is in the hindbrain. Number: 335 All the following muscles have an insertion on the radius, EXCEPT: A. Supinator B. Pronator quadratus C. Pronator teres D. Biceps brachii E. Brachialis Select the single best answer ABCDE Correct Answer: E Brachialis arises from the front of the lower two-thirds of the humerus and the medial intermuscular septum. Its upper fibres clasp the deltoid insertion; some fibres arise from the lower part of the spiral groove. The broad muscle flattens to cover the anterior part of the elbow joint and is inserted by mixed tendon and muscle fibres into the coronoid process and tuberosity of the ulna.

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Number: 336 Which artery and region that it primarily supplies are incorrectly paired: A. Right gastroepiploic : greater curvature B. Left gastric cardiac part of stomach C. Right colic ascending colon D. Right gastric : pyloris of stomach E. Middle colic: descending colon Select the single best answer ABCDE Correct Answer: E The middle colic supplies the transverse colon.

Number: 336 Which artery and region that it primarily supplies are incorrectly paired: A. Right gastroepiploic : greater curvature B. Left gastric cardiac part of stomach C. Right colic ascending colon D. Right gastric : pyloris of stomach E. Middle colic: descending colon Select the single best answer ABCDE Correct Answer: E The middle colic supplies the transverse colon. Number: 337 The recurrent (or inferior) laryngeal nerve innervates all the intrinsic laryngeal muscles, EXCEPT: A. Lateral cricoarytenoid B. Posterior cricoarytenoid C. Cricothyroid D. Vocalis E. Aryepiglottis Select the single best answer

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ABCDE Correct Answer: C Cricothyroid Cricothyroid arises from the arch of the cricoid backwards to fan out towards its attachment to the inferior horn and lower border of the thyroid lamina. Its contraction causes the arch of the cricoid and the Adam's apple to approach each other. The effect of contraction is to lengthen the vocal fold. Number: 338 With regard to Pectoralis Major: 1. It is supplied by the pectoral nerves. 2. It can abduct and laterally rotate the humerus. 3. Its contraction is used in testing the mobility of a breast lump. 4. Its lower border forms the posterior axillary fold. A: 1,2,3 Correct B: 1,3 Correct C: 2,4 Correct D: 4 Correct E: All Correct ABCDE Correct Answer: B Pectoralis Major is a medial rotator of the arm. In combination with latissimus dorsi it is also a powerful adductor of the arm. Number: 339 The ulnar nerve: 1. Supplies flexor carpi ulnaris muscle. 2. Supplies abductor pollicis brevis. 3. Arises from medial cord of the brachial plexus 4. Supplies the 2nd lumbrical muscle. A: 1,2,3 Correct B: 1,3 Correct C: 2,4 Correct D: 4 Correct E: All Correct

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ABCDE Correct Answer: B In 95% of cases flexor carpi ulnaris is supplied by the ulnar nerve. The muscles of the thenar eminence (abductor pollicis brevis, flexor pollicis brevis and opponens pollicis) are supplied by the median nerve. The ulnar nerve is the largest branch of the medial cord of the brachial plexus. The 1st and 2nd lumbricals are supplied by the median nerve. Number: 356 In this plan of the right lumbar plexus, The nerve marked 'A' is: A. Ilio-Hypogastric. B. Lateral cutaneous nerve of the thigh. C. Femoral. D. Obturator. E. Genitofemoral Select the single best answer

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ABCDE Correct Answer: D The lumbar plexus is derived from the anterior primary rami of the 1st, 2nd, 3rd and part of the 4th lumbar nerve roots. About 50 percent of subjects receive an additional contribution from TI2. In much the same way as the brachial plexus, the lumbar plexus may be prefixed, with its lowest contribution from L3, or postfixed, when it extends to L5. The plexus assembles in front of the transverse processes of the lumbar vertebrae within the substance of the psoas major. LI, joined in 50 per cent of cases by a branch from TI2, divides into an upper and lower division. The upper division gives rise to the iliohypogastric and ilioinguinal nerves; the lower joins a branch from L2 to form the genito-femoral nerve. The rest of L2, together with L3 and the contribution to the plexus from L4, divide into dorsal and ventral divisions. Dorsal divisions L2 and 3 form the lateral cutaneous nerve of the thigh and L2, 3 and 4 form the femoral nerve. The ventral branches join into the obturator nerve (L2, 3, 4) and, when present, the accessory abturator nerve (L3, 4). 30

Number: 357 In this plan of the right lumbar plexus, The nerve marked 'B' is: A. Ilio-Hypogastric. B. Lateral cutaneous nerve of the thigh. C. Femoral. D. Obturator. E. Genitofemoral Select the single best answer

ABCDE Correct Answer: C The lumbar plexus is derived from the anterior primary rami of the 1st, 2nd, 3rd and part of the 4th lumbar nerve roots. About 50 percent of subjects receive an additional contribution from TI2. In much the same way as the brachial plexus, the lumbar plexus may be prefixed, with its lowest contribution from L3, or postfixed, when it extends to L5. The plexus assembles in front of the transverse processes of the lumbar vertebrae within the substance of the psoas major. LI, joined in 50 per cent of cases by a branch from TI2, divides into an upper and lower division. The upper division gives rise to the iliohypogastric and ilioinguinal nerves; the lower joins a branch from L2 to form the genito-femoral nerve. The rest of L2, together with L3 and the contribution to the plexus from L4, divide into dorsal and ventral divisions. Dorsal divisions L2 and 3 form the lateral cutaneous nerve of the thigh and L2, 3 and 4 form the femoral nerve. The ventral branches join into the obturator nerve (L2, 3, 4) and, when present, the accessory abturator nerve (L3, 4). Number: 358 In this plan of the right lumbar plexus, The nerve marked 'C' is: A. Ilio-Hypogastric. B. Lateral cutaneous nerve of the thigh. C. Femoral. D. Obturator. E. Genitofemoral Select the single best answer

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ABCDE Correct Answer: B The lumbar plexus is derived from the anterior primary rami of the 1st, 2nd, 3rd and part of the 4th lumbar nerve roots. About 50 percent of subjects receive an additional contribution from TI2. In much the same way as the brachial plexus, the lumbar plexus may be prefixed, with its lowest contribution from L3, or postfixed, when it extends to L5. The plexus assembles in front of the transverse processes of the lumbar vertebrae within the substance of the psoas major. LI, joined in 50 per cent of cases by a branch from TI2, divides into an upper and lower division. The upper division gives rise to the iliohypogastric and ilioinguinal nerves; the lower joins a branch from L2 to form the genito-femoral nerve. The rest of L2, together with L3 and the contribution to the plexus from L4, divide into dorsal and ventral divisions. Dorsal divisions L2 and 3 form the lateral cutaneous nerve of the thigh and L2, 3 and 4 form the femoral nerve. The ventral branches join into the obturator nerve (L2, 3, 4) and, when present, the accessory abturator nerve (L3, 4).

Number: 359 In this view of the dorsal surface of the left first rib, the structure crossing the rib at point 'A' is: A. The Subclavian vein. B. The Subclavian artery. C. The Brachial plexus. D. The Thoracic duct. E. The Scalenus Anterior. Select the single best answer

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ABCDE Correct Answer: A The upper surface of the shaft of the 1st rib slopes down at about 45 degrees, and is at the root of the neck. It is grooved obliquely at its greatest lateral convexity. The groove between 'B' and 'C' is called the subclavian groove. It lodges the lower trunk of the brachial plexus. The fibres in contact with the rib are all from T1, and the C8 fibres lie above them, not yet intermingled. The subclavian artery has its upward convexity Iying more transversely. The artery does not lie in the groove, and it touches only the outer border of the rib. Between the groove and the tubercle the large quadrangular area of the upper surface gives attachment to scalenus anterior. Number: 360 In this view of the dorsal surface of the left first rib, the muscle inserted at point 'B' is: A. Scalenus Medius. B. Scalenus Posterior. C. Posterior belly of Omo-hyoid. D. Scalenus Anterior. E. None of the above. Select the single best answer 33

ABCDE Correct Answer: D The upper surface of the shaft of the 1st rib slopes down at about 45 degrees, and is at the root of the neck. It is grooved obliquely at its greatest lateral convexity. The groove between 'B' and 'C' is called the subclavian groove. It lodges the lower trunk of the brachial plexus. The fibres in contact with the rib are all from T1, and the C8 fibres lie above them, not yet intermingled. The subclavian artery has its upward convexity Iying more transversely. The artery does not lie in the groove, and it touches only the outer border of the rib. Between the groove and the tubercle the large quadrangular area of the upper surface gives attachment to scalenus anterior.

Number: 363 In this view of the dorsal surface of the left first rib, the muscle inserted at point 'C' is: A. Scalenus Medius. B. Scalenus Posterior. C. Posterior belly of Omo-hyoid. D. Scalenus Anterior. E. None of the above. Select the single best answer

ABCDE Correct Answer: A The scalenus medius: The scalenus medius arises from the posterior tubercles and costo-transverse lamellae of all the cervical vertebrae and is inserted into the quadrangular area between the neck and subclavian groove of the first rib . Number: 365 With regard to the brachial plexus the nerve labelled 'A' is: A. Lateral Pectoral. B. Musculocutaneous. C. Suprascapular. D. Median E. Nerve to subclavius

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Select the single best answer

ABCDE Correct Answer: B The musculocutaneous nerve: The musculocutaneous nerve (C5, 6, 7) is the continuation of the lateral cord after this has given off the lateral head of the median nerve at the lower border of pectoralis minor. Because of its derivation from the lateral cord, the nerve naturally lies lateral to the axillary artery. It first supplies and then pierces coracobrachialis, then descends downwards and laterally between biceps and brachialis, supplying both these muscles. The nerve emerges between biceps tendon and brachioradialis, pierces the deep fascia of the antecubital fossa and continues downwards as the lateral cutaneous nerve of the forearm.

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Number: 366 With regard to the brachial plexus the nerve labelled 'B' is: A. Lateral Pectoral. B. Musculocutaneous. C. Suprascapular. D. Median E. Nerve to subclavius Select the single best answer ABCDE Correct Answer: D The median nerve: The median nerve (C5, 6, 7, 8, TI) carries fibres from all the roots of the brachial plexus; C5, 6 and 7 from the lateral head, which is derived from the lateral cord of the plexus, and C8 and TI from the medial head, derived from the medial cord. The two origins of the nerve unite in front of the third part of the axillary artery. The nerve descends through the arm first on the lateral side of the brachial artery, then on its medial side, crossing the artery at the mid-point of the upper arm at the insertion of coracobrachialis. Usually the nerve passes across the front of the artery, but occasionally crosses behind it. Number: 367 With regard to the brachial plexus the nerve labelled 'E' is: A. Phrenic B. Nerve to Serratus Anterior C. Suprascapular. D. Nerve to rhomboids E. Nerve to subclavius Select the single best answer ABCDE Correct Answer: B Nerve to Serratus Anterior: The long thoracic nerve (nerve to serratus anterior) arises from the roots of the brachial plexus (C5, 6, 7). The branches from C5 and 6 join in the scalenus medius muscle and emerge from its lateral border as a single trunk which enters the axilla by passing over the first digitation of serratus anterior. The contribution from C7 also passes over the first digitation of serratus

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anterior and joins the former nerve on the medial wall of the axilla (i.e., on the surface of serratus anterior) to form the nerve to serratus anterior. The nerve lies behind the midaxillary line (i.e., behind the lateral branches of the intercostal arteries) on the surface of the muscle, deep to the fascia, and is thus protected in operations on the axilla. The muscle is supplied segmentally; C5 into the upper two digitations, C6 into the next two, and C7 into the lower four digitations. Number: 381 The structure marked 'A' on this lateral view of the pharynx is: A. Superior Constrictor. B. Middle Constrictor. C. Inferior Constrictor. D. Hyoglossus. E. Buccinator. Select the single best answer

ABCDE

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Correct Answer: C Inferior Constrictor: The inferior constrictor, which is the thickest of the pharyngeal constrictors, arises from the side of the cricoid, from the tendinous arch over the cricothyroid muscle and from the oblique line on the lamina of the thyroid cartilage. The muscle consists functionally of two parts: the lower portion, arising from the cricoid (the cricopharyageus), which acts as a sphincter and the upper portion, with obliquely placed fibres which arise from the thyroid cartilage, which has a propulsive action. Number: 383 The structure marked 'C' on this lateral view of the pharynx is: A. Superior Constrictor. B. Middle Constrictor. C. Inferior Constrictor. D. Hyoglossus. E. Buccinator. Select the single best answer ABCDE Correct Answer: D Hyoglossus: The hyoglossus muscle arises from the length of the greater horn of the hyoid bone and from the body of that bone lateral to genio-hyoid. It extends as a quadrilateral sheet on the side of the tongue; its upper border, interdigitating at right angles with the fibres of stylo-glossus, is attached to the side of the tongue. Number: 387 The structure marked 'B' on this lateral view of the pharynx is: A. Superior Constrictor. B. Middle Constrictor. C. Inferior Constrictor. D. Hyoglossus. E. Buccinator. Select the single best answer ABCDE Correct Answer: A

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The Superior Constrictor arises from the medial pterygoid plate and is inserted into the pharyngeal ligament. Number: 395 The phrenic nerve: 1. Arises predominantly from the third cervical nerve 2. Runs in front of the root of the lung 3. Is a purely motor nerve 4. Iinnervates the diaphragm from below A: 1,2,3 Correct B: 1,3 Correct C: 2,4 Correct D: 4 Correct E: All Correct ABCDE Correct Answer: C The phrenic nerve (C3, 4, 5) is, the most important branch of the cervical plexus. It provides the motor innervation of the diaphragm (apart from a clinically insignificant contribution to the crura from T11 and T12) and transmits proprioceptive sensory fibres from the central part of the diaphragm. In addition filaments are supplied to the pleura and pericardium. Number: 419 Which artery is NOT a branch of the internal carotid artery? A. Middle cerebral B. Anterior cerebral. C. Posterior cerebral. D. Choroidal. E. Retinal. Select the single best answer ABCDE Correct Answer: C The posterior cerebral arteries are terminal branches of the basilar artery.

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Number: 420 Afferent fibres from the carotid sinus travel via the: A. Glossopharyngeal nerve. B. Vagus nerve. C. Cervical sympathetics. D. Recurrent laryngeal nerve. E. Accessory nerve. Select the single best answer ABCDE Correct Answer: A The sinu-carotid nerve (a branch of the glosspharyngeal nerve) supplies the carotid sinus and carotid body. The fibres pass centrally to the vasomotor centre. Number: 421 The radial artery : 1. Lies between flexor carpi radialis and brachioradialis at the wrist. 2. Passes beneath the flexor retinaculum. 3. Accompanies superficial branches of the radial nerve at the wrist. 4. Has no branches in the forearm. A: 1,2,3 Correct B: 1,3 Correct C: 2,4 Correct D: 4 Correct E: All Correct ABCDE Correct Answer: B The radial artery has a recurrent branch at the elbow which anastomoses with branches from the ulnar and interosseous arteries. It also supplies muscular branches to all the muscles which it passes. The flexor retinaculum contains the median nerve and flexor tendons of the thumb and fingers.

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Number: 432 The inferior vena cava: 1. Is formed at the 5th lumbar vertebral level. 2. Passes through the tendinous part of the diaphragm. 3. Passes behind the horizontal part of the duodenum. 4. Has a valve at its opening in the right atrium. A: 1,2,3 Correct B: 1,3 Correct C: 2,4 Correct D: 4 Correct E: All Correct ABCDE Correct Answer: E The inferior vena cave is a large, valveless, venous trunk that receives the blood from the lower limbs, and much of the blood from the back and from the walls and contents of the abdomen and pelvis It is formed by the junction of the two common iliac veins, slightly below and to the right of the bifurcation of the aorta. It ascends at the right of the aorta, through the central tendon of the diaphragm, and empties into the right atrium. From below upward it lies behind peritoneum (crossed by the root of the mesentery and right gonadal vessels), duodenum and pancreas, portal vein, epiploic foramen, and the liver, The right renal artery crosses behind it. The tributaries of the inferior vena cava are the common iliac, gonadal, renal, suprarenal, inferior phrenic, lumbar, and hepatic veins. Number: 433 With regard to the foetal circulation: 1. Most of the blood bypasses the liver in the ductus venosus. 2. The ductus arteriosus connects the root of the right pulmonary trunk to the descending aorta. 3. The valve of the inferior vena cava helps to direct the blood through the foramen ovale. 4. The umblical arteries arises from the external iliac artery. A: 1,2,3 Correct B: 1,3 Correct C: 2,4 Correct D: 4 Correct E: All Correct

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ABCDE Correct Answer: B The economy of the foetal circulation is improved by three short-circuiting arrangements, all of which cease to function at the time of birth. The three short-circuiting structures are the ductus venosus, the forarnen ovale and the ductus arteriosus. The Ductus Venosus. Oxygenated blood returns from the placenta by the (left) umbilical vein, which joins the left branch of the portal vein in the porta hepatis. This oxygenated blood short-circuits the sinusoids of the liver; it is conveyed directly to the inferior vena cava by a channel called the ductus venosus. The ductus venosus lies along the inferior surface of the liver, between the attached layers of the lesser omentum. After birth, when blood no longer flows along the thrombosed umbilical vein, the blood in the ductus venosus clots and the ductus venosus becomes converted into a fibrous cord, the ligamentum venosum, lying deep in the cleft bounding the caudate lobe of the liver. The intra-abdominal part of the umbilical vein persists as a fibrous cord, the ligamentum teres. The two are continuous. The Foramen Ovale. The interatrial septum of the foetal heart is patent, being perforated by the foramen ovale. Blood brought to the right atrium by the inferior vena cava is directed by its 'valve' through the aperture in the inter-atrial septum and so enters the left atrium. The oxygenated placental blood is thus made to by-pass the right ventricle and the airless lungs, and is directed into the left ventricle and aorta and so to the carotid arteries. After birth this aperture, the foremen ovale, is closed by approximation and overlap of flanges of cardiac muscle which act from below and above like shutters. The two flanges are the septum primum and the septum secundum. The two flanges overlap and adhere together, so closing the interatrial septum. The site of union is marked by a shallow depression, the fossa ovalis, in the right side of the interatrial septum. After closure of the foramen ovale all the blood in the right atrium perforce passes into the right ventricle and so to the lungs. The Ductus Arteriosus. It has already been noted that oxygenated blood in the umbilical vein passes via the ductus venosus, inferior vena cava and right atrium through the foremen ovale to the left side of the heart locally, of a raised oxygen tension. and so to the head. Venous blood from the head is returned by way of the brachio-cephalic veins to the superior vena cava. In the right atrium this venous blood stream crosses the stream of oxygenated blood brought there via the inferior vena cava. The two streams of blood scarcely mix with each other. The de-oxygenated blood from the superior vena cave passes through the right atrium into the right ventricle and so into the pulmonary trunk. It now short-circuits the airless lungs by the ductus arteriosus. This is a thick artery joining the left branch of the pulmonary trunk to the aorta, distal to the origin of the three branches of the aortic arch. The de-oxygenated blood thus passes distally along the aorta and via the umbilical arteries to the placenta to be re-oxygenated. After birth the ductus arteriosus is occluded by contraction of its muscular walls. It persists as a fibrous band, the ligamentum arteriosum, which connects the commencement of the left pulmonary artery to the concavity of the arch of the aorta. After the closure of the ductus arteriosus blood from the right ventricle perforce circulates through the lungs.

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Number: 436 In this diagram of the cervical plexus, the nerve labelled 'A' is: A. Phrenic. B. Supraclavicular. C. Descendens cervicalis. D. Descendens hypoglossi. E. Anterior cutaneous nerve of the neck. Select the single best answer ABCDE Correct Answer: A Phrenic. The phrenic nerve (C3, 4, 5) is the most important branch of the cervical plexus. It provides the motor innervation of the diaphragm (apart from a clinicallyinsignificant contribution to the crura from T11 and T12) and transmits proprioceptive sensory fibres from the central part of the diaphragm. In addition filaments are supplied to the pleura and pericardium. The principal component of the nerve is derived from the anterior primary ramus of C4 but contributions are also provided from C3 and C5. The three roots of the nerve join at the lateral border of scalenus anterior and then the fully constituted nerve runs downwards and medially across the anterior face of the muscle, covered by, and showing through, the prevertebral fascia. On scalenus anterior the phrenic nerve is overlapped by the internal jugular vein and sternomastoid, and is crossed by the inferior belly of the omohyoid and by the transverse cervical and transverse scapular vessels. On the left side, in addition, the nerve is crossed by the thoracic duct. Number: 437 In this diagram of the cervical plexus, the nerve labelled 'B' is: A. Phrenic. B. Supraclavicular. C. Descendens cervicalis. D. Descendens hypoglossi. E. Anterior cutaneous nerve of the neck. Select the single best answer

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ABCDE Correct Answer: C Descendens Cervicalis. The ansa cervicalis lies on the front of the internal jugular vein and gives branches to the infrahyoid muscles. It is formed by union of superior and inferior rami. The superior ramus (descendens hypoglossi) is a branch of the hypoglossal nerve given off where the nerve loops just below the posterior belly of the digastric muscle, on the occipital, external carotid and lingual arteries. It runs down on the front of the internal jugular vein. It contains only C1 fibres, which have hitch-hiked along the hypoglossal nerve. The inferior ramus (descendens cervicalis) is formed by union of a branch each from C2 and C3 in the cervical plexus. The single nerve so formed spirals from behind around the internal jugular vein and runs down to join the superior ramus at a variable level. Sometimes a wide loop is formed over the lower part of the vein and the branches arise from the loop. Sometimes the two nerves join, Y-shaped, high up and the branches are given off from the stem of the Y. In either case they are distributed to the infrahyoid muscles (sterno-hyoid, stereo-thyroid and omo-hycid) segmentally, Cl, C2 and C3 from above down. Number: 438 In this diagram of the cervical plexus, the nerve labelled 'C' is: A. Phrenic. B. Supraclavicular. C. Descendens cervicalis. D. Descendens hypoglossi. E. Anterior cutaneous nerve of the neck. Select the single best answer ABCDE Correct Answer: D Descendens hypoglossi. The ansa cervicalis lies on the front of the internal jugular vein and gives branches to the infrahyoid muscles. It is formed by union of superior and inferior rami. The superior ramus (descenders hypoglossi) is a branch of the hypoglossal nerve given off where the nerve loops just below the posterior belly of the digastric muscle, on the occipital, external carotid and lingual arteries. It runs down on the front of the internal jugular vein. It contains only C1 fibres, which have hitch-hiked along the hypoglossal nerve. The inferior ramus (descendens cervicalis) is formed by union of a branch each from C2 and C3 in the cervical plexus. The single nerve so formed spirals from behind around the internal

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jugular vein and runs down to join the superior ramus at a variable level. Sometimes a wide loop is formed over the lower part of the vein and the branches arise from the loop. Sometimes the two nerves join, Y-shaped, high up and the branches are given off from the stem of the Y. In either case they are distributed to the infrahyoid muscles (sterno-hyoid, stereo-thyroid and omo-hycid) segmentally, Cl, C2 and C3 from above down. Number: 439 At birth, the spinal cord is most likely to terminate at: A. L1. B. L2. C. L3. D. L4. E. L5. Select the single best answer ABCDE Correct Answer: C L3. By adulthood it has migrated upwards to the L1-2 region. Number: 440 Which of the following nerves contribute to the supply of the external auditory meatus: 1. Auriculo-temporal. 2. Great auricular. 3. Auricular branch of the vagus. 4. Lesser occipital. A: 1,2,3 Correct B: 1,3 Correct C: 2,4 Correct D: 4 Correct E: All Correct ABCDE Correct Answer: B The nerve supply of the external auditory meatus is from the auriculo-temporal nerve overlapped by the facial nerve and the auricular branch of the vagus.

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The skin of the auricle is supplied by the great auricular and the auriculo-termporal nerves. The great auricular nerve supplies the whole of the cranial surface and the lateral surface below the meatus with fibres from C2. The auriculo-temporal nerve supplies the outer surface of the tympanic membrane, the external acoustic meatus and the skin of the auricle above this level. The auricular branch of the vagus supplies the posteroinferior quadrant of the tympanic membrane and skin of the adjoining meatus and a small area of skin of the cranial surface near the mastoid. The facial nerve by branches from the tympanic plexus also supplies the cutaneous surface of the tympanic membrane and external meatus, and these areas show vesicles in cases of facial herpes. The lesser occipital nerve (C2) overlaps the great auricular nerve at the upper margin of the cranial surface. The lesser occipital nerve (C2) is a slender branch that hooks around the accessory nerve and runs up along the posterior border of stereo-mastoid to supply the posterior part of the neck below the superior nuchal line (i.e., over the upper part of stereo-mastoid). It may overlap to the tip of the auricle. Number: 471 The greater splanchnic nerves usually synapse in the: A. Superior mesenteric ganglion B. Coeliac ganglion C. Hypogastric plexus D. Inferior mesenteric ganglion E. Ganglia of the lower thoracic sympathetic trunk Select the single best answer ABCDE Correct Answer: B The greater splachnic nerves arises from T5-T9 and pass forwards and downwards on the sides of the vertebral bodies. They pierce the crus of the diaphragm and then join the coeliac ganglion. Number: 474 The sixth cranial nerve: 1. Supplies the superior oblique muscle 2. Passes through the superior orbital fissure 3. Innervates the lacrimal gland 4. May be involved in an injury to the petrous part of the temporal bone

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A: 1,2,3 Correct B: 1,3 Correct C: 2,4 Correct D: 4 Correct E: All Correct ABCDE Correct Answer: C The abducent nerve, like the trochlear nerve, supplies only one eye muscle, the lateral rectus.Its nucleus is part of the somatic efferent column and lies immediately deep to the floor of the 4th ventricle in the upper part of the pons. From this nucleus, fibres pass through the pontine tegmentum to emerge on the base of the brain at the junction of the pons and medulla. The nerve then passes forwards to enter the cavernous sinus. Here it lies lateral to the internal carotid artery and medial to the IIIrd, IVth and Vth cranial nerves. Passing through the tendinous ring just below the IIIrd nerve, it enters the orbit to pierce the deep surface of the lateral rectus. Because of its long and oblique intracranial course, the Vith nerve is frequently involved in basal skull injuries. If damaged, diplopia and a covergent squint are the result. Number: 514 Concerning a typical intercostal nerve: 1. It arises from the posterior primary ramus of a thoracic spinal nerve. 2. It lies superior to the artery in the costal groove. 3. It lies between the internal and external intercostal muscles. 4. It is both motor and sensory. A: 1,2,3 Correct B: 1,3 Correct C: 2,4 Correct D: 4 Correct E: All Correct ABCDE Correct Answer: D The intercostal nerves are the primary anterior rami of the thoracic spinal nerves. They are mixed, motor (to the intercostal muscle) and sensory (serving skin). From above downwards in the costal groove lie the intercostal vein, artery and nerve. The vein, artery and nerve lie between the internal intercostal and the transverse thoracis muscles.

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Number: 534 In this posterior view of the right popliteal fossa, the structure labelled 'A' is: A. Biceps Femoris. B. Semimembranosus. C. Semitendinosus. D. Gracilis. E. Sartorius. Select the single best answer ABCDE Correct Answer: A Biceps Femoris. - The long head originates from a common tendon with semitendinosus from the superior medial quadrant of the posterior portion of the ischial tuberosity; and the short head from the lateral lip of the linea aspera, lateral supracondylar ridge of femur, and lateral intermuscular septum of the thigh. It is inserted into the fibular head; also the lateral collateral ligament and lateral tibial condyle. Its action is to flex the knee, and also rotate the tibia laterally; the long head also extends the hip joint. The long head is innervated by tibial nerve; and the short head by common peroneal nerve. Its arterial supply is from perforating branches of the profunda femoris artery, the inferior gluteal artery, and superior muscular branches of the popliteal artery.

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Number: 535 In this posterior view of the right popliteal fossa, the structure labelled 'B' is: A. Tibial N. B. Lateral Cutaneous N. of the calf. C. Sural Communicating N. D. Posterior Tibial N. E. Sural N. Select the single best answer ABCDE Correct Answer: A Tibial N. Number: 536 In this posterior view of the right popliteal fossa, the structure labelled 'C' is: A. Tibial N. B. Lateral Cutaneous N. of the calf. C. Sural Communicating N. D. Posterior Tibial N. E. Sural N. Select the single best answer 49

ABCDE Correct Answer: C Sural Communicating N. Number: 537 In this posterior view of the right popliteal fossa, the structure labelled 'D' is: A. Biceps Femoris. B. Semimembranosus. C. Semitendinosus. D. Gracilis. E. Sartorius. Select the single best answer ABCDE Correct Answer: C Semitendinosus originates from a common tendon with long head of biceps femoris on the superior medial quadrant of the posterior portion of the ischial tuberosity. It is inserted into the superior aspect of the medial portion of tibial shaft. Its action is to extend the thigh, flex the knee, and rotate the tibia medially - especially when the knee is flexed. It is innervated by the tibial nerve and draws its blood supply from perforating branches of profunda femoris, the inferior gluteal artery, and superior muscular branches of the popliteal artery. Number: 538 In this posterior view of the right popliteal fossa, the structure labelled 'E' is: A. Biceps Femoris. B. Semimembranosus. C. Semitendinosus. D. Gracilis. E. Sartorius. Select the single best answer ABCDE Correct Answer: B Semimembranosus takes origin from the superior lateral quadrant of the ischial tuberosity and is inserted onto the posterior surface of the medial tibial condyle. It acts to extend the thigh, flex the knee, and rotate the tibia medially, especially when the knee is flexed.

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It is innervated by the tibial nerve and derives its arterial supply from perforating branches of the profunda femoris artery, inferior gluteal artery, and the superior muscular branches of the popliteal artery. Number: 577 Which of the following vertebrae has the most prominent spinous process? A. T1. B. T2. C. C7. D. T11. E. T12. Select the single best answer ABCDE Correct Answer: C C7 - 'Vertebra Prominens'. Number: 586 The femoral sheath: 1. Contains the femoral nerve, artery and vein 2. Has the inguinal ligament as its anterior border 3. Has the lacunar ligament as its lateral border 4. Has the pectineal ligament as its posterior border A: 1,2,3 Correct B: 1,3 Correct C: 2,4 Correct D: 4 Correct E: All Correct ABCDE Correct Answer: C The femoral nerve lies outside the femoral sheath which contains the artery, vein and lymphatics. The lacunar ligament is on the medial border of the femoral sheath.

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Number: 712 In the case of a patient sitting upright with his arms by his side, a line drawn between the tips of the scapulae will correspond to the vertebral body of: A. T6. B. T7. C. T8. D. T9. E. T10. Select the single best answer ABCDE Correct Answer: B Vertebra Prominens is C7. A line drawn between the tips of the scapulae corresponds to the vertebral body of T7. A line drawn between the superior margin of the iliac crests is level with the vertebral body of L4. Number: 748 A patient presents with a history of low back pain and sciatica. The pain radiates to the little toe, the ankle reflex is absent and the patient has difficulty in everting the foot. Which nerve root is likely to be trapped? A. L3 B. L4 C. L5 D. S1 E. S2 Select the single best answer ABCDE Correct Answer: D The root supply to the peroneal muscles (which control eversion of the foot and which also participate in the the reflex arc of the ankle jerk reflex) is S1 via the tibial and superficial peroneal nerves. The sensory dermatome of the S1 root gives innervation to the postero-lateral aspect of the leg and foot down to and including the little toe and sole of foot.

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Number: 777 Which of the following are branches of the MEDIAL CORD of the brachial plexus? 1. Ulnar Nerve. 2. Axillary Nerve. 3. Medial Pectoral Nerve. 4. Radial Nerve. A: 1,2,3 Correct B: 1,3 Correct C: 2,4 Correct D: 4 Correct E: All Correct ABCDE Correct Answer: B The axillary nerve is a branch of the posterior cord. The radial nerve is a branch of the posterior cord. Number: 778 Which of the following are branches of the POSTERIOR CORD of the brachial plexus? 1. Dorsal scapular nerve. 2. Nerve to serratus anterior. 3. Nerve to subclavius. 4. Upper subscapular nerve. A: 1,2,3 Correct B: 1,3 Correct C: 2,4 Correct D: 4 Correct E: All Correct ABCDE Correct Answer: D The dorsal scapular nerve, nerve to serratus anterior and the nerve to subclavius all arise from the roots of the brachial plexus.

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Number: 779 Which of the following is a branch of the LATERAL CORD of the brachial plexus? A. Suprascapular nerve. B. Lower subscapular nerve. C. Medial pectoral nerve. D. Musculo-cutaneous nerve. E. Upper subscapular nerve. Select the single best answer ABCDE Correct Answer: D The suprascapular nerve arises from the upper trunk of the plexus. The upper and lower subscapular nerves arise from the posterior cord of the plexus. The medial pectoral nerve arise from the medial cord of the plexus. Number: 779 Which of the following is a branch of the LATERAL CORD of the brachial plexus? A. Suprascapular nerve. B. Lower subscapular nerve. C. Medial pectoral nerve. D. Musculo-cutaneous nerve. E. Upper subscapular nerve. Select the single best answer ABCDE Correct Answer: D The suprascapular nerve arises from the upper trunk of the plexus. The upper and lower subscapular nerves arise from the posterior cord of the plexus. The medial pectoral nerve arise from the medial cord of the plexus.

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Number: 831 The right middle lobe bronchus: 1. Divides into superior and inferior segmental bronchi. 2. Is medial to the right middle lobe artery. 3. Arises from the posterior aspect of the right main bronchus. 4. Is about 1.5cms in length. A: 1,2,3 Correct B: 1,3 Correct C: 2,4 Correct D: 4 Correct E: All Correct ABCDE Correct Answer: C The right middle lobe bronchus divides into medial and lateral segmental bronch. It is about 1.5cms in length and arises from the anterior aspect of the right main bronchus. The right middle lobe artery runs on its lateral side and the right middle lobe vein on its medial side. See: Anesthesia for Thoracic Surgery.2nd ed.Jonathan L. Benumof. ISBN: 0721644678. Publisher: WB Saunders. Number: 832 In the left lung, the number of bronchopulmonary segments is: A. 7. B. 8. C. 9. D. 10. E. 11. Select the single best answer ABCDE Correct Answer: B This is a 'trick' question. In one sense, there are 10 bronchopulmonary segments in the left lung, but the apical and posterior segments of the upper lobe and the anterior and medial basal segments of the lower lobe both combine into single segments. Hence the correct answer is 8. These are: Upper lobe: Apico-posterior

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Anterior Lingula: Superior Inferior Lower Lobe: Superior ('Apical') Anterior-medial basal Lateral basal Postero-basal See: Anesthesia for Thoracic Surgery.2nd ed.Jonathan L. Benumof. ISBN: 0721644678. Publisher: WB Saunders. Number: 833 In the right lung, the number of bronchopulmonary segments is: A. 7. B. 8. C. 9. D. 10. E. 11. Select the single best answer ABCDE Correct Answer: D There are 10 bronchopulmonary segments in the right lung. These are: Upper lobe: Apical Posterior Anterior Middle Lobe: Medial Lateral Lower Lobe: Superior ('Apical') Anterior basal Posterior basal Medial basal

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Lateral basal See: Anesthesia for Thoracic Surgery.2nd ed.Jonathan L. Benumof. ISBN: 0721644678. Publisher: WB Saunders. Number: 854 The incidence of probe-patent foramen ovale (PFO) in the general population is approximately: A. 5%. B. 10%. C. 15%. D. 20%. E. 25%. Select the single best answer ABCDE Correct Answer: E The incidence of PFO in the normal population is approximately 25%, as determined by postmortem examination. See: Hagen PT, Scholz DG, Edwards WD. Incidence and size of patent foramen ovale during the first 10 decades of life: an autopsy study of 965 normal hearts. Mayo Clin Proc 1984; 59: 17 20. Sweeney LJ, Rosenquist GC. The normal anatomy of the atrial septum in the human heart. Am Heart J 1979; 98: 1949. Number: 857 Abduction of the vocal cords is achieved by contraction of the: A. Posterior cricoarytenoids. B. Lateral cricoarytenoids. C. Interarytenoids. D. Cricothyroids. E. Thyroarytenoids. Select the single best answer ABCDE Correct Answer: A

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The posterior cricoarytenoids are the (only) cord abductors. They are innervated by the recurrent laryngeal nerve. Number: 858 Adduction of the vocal cords is achieved by contraction of the: A. Posterior cricoarytenoids. B. Lateral cricoarytenoids. C. Aryepiglottics. D. Cricothyroid. E. Thyroarytenoid. Select the single best answer ABCDE Correct Answer: B The lateral cricoarytenoids (and the interarytenoids) are the cord adductors. The lateral cricoarytenoids are innervated by the recurrent laryngeal nerve, while the interarytenoids are innervated by both the recurrent and superior laryngeal nerves. Number: 860 In this posterior view of the intrinsic muscles of the larynx, the muscle labelled 'A' is: A. Interarytenoid. B. Posterior cricoarytenoid. C. Aryepiglottic. D. Thyroarytenoid. E. Thyroepiglottic. Select the single best answer

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ABCDE Correct Answer: C Muscle 'A' is the Aryepiglottic. It is innervated by the recurrent laryngeal nerve.

Number: 861 In this posterior view of the intrinsic muscles of the larynx, the muscle labelled 'B' is: A. Interarytenoid. B. Posterior cricoarytenoid. C. Aryepiglottic. D. Thyroarytenoid. E. Thyroepiglottic. Select the single best answer ABCDE Correct Answer: A Muscle 'B' is the transverse component of the Interarytenoid. It is innervated by the recurrent laryngeal nerve and probably by branches from the superior laryngeal nerve.

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Number: 861 In this posterior view of the intrinsic muscles of the larynx, the muscle labelled 'B' is: A. Interarytenoid. B. Posterior cricoarytenoid. C. Aryepiglottic. D. Thyroarytenoid. E. Thyroepiglottic. Select the single best answer ABCDE Correct Answer: A Muscle 'B' is the transverse component of the Interarytenoid. It is innervated by the recurrent laryngeal nerve and probably by branches from the superior laryngeal nerve. Number: 862 In this posterior view of the intrinsic muscles of the larynx, the muscle labelled 'C' is: A. Interarytenoid. B. Posterior cricoarytenoid. C. Aryepiglottic. D. Thyroarytenoid. E. Thyroepiglottic. Select the single best answer ABCDE Correct Answer: B Muscle 'C' is the posterior cricoarytenoid. It is innervated by the recurrent laryngeal nerve.

Number: 879 Klumpke's paralysis may be associated with: 1. Wasting of the small muscles of the hand. 2. Horner's syndrome. 3. Sensory loss on the medial side of the arm. 4. An inability to extend the metacarpophalangeal joints.

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A: 1,2,3 Correct B: 1,3 Correct C: 2,4 Correct D: 4 Correct E: All Correct ABCDE Correct Answer: A Klumpke's paralysis is caused by upward traction on the arm (as may occur in forcible breech delivery or, during anaesthesia, by wide abduction of the limb when an arm board is used) which results in damage to the lowest root of the brachial plexus (T1). This provides the segmental supply of the intrinsic muscles of the hand. The hand assumes a clawed appearance because of the unopposed actions of the long flexors and extensors of the fingers. (The extensors, which are inserted into the bases of the proximal phalanges, extend the metacarpophalangeal joints; flexor profundus and sublimis, inserted respectively into the distal and middle phalanges, flex the interphalangeal joints.) An area of sensory loss may be present on the inner aspect of the arm and upper forearm. Traction may also tear the white ramus communicans from T1 to the stellate ganglion, so that there may be an associated Horner's syndrome. Number: 934 With respect to the veins of the upper limb found at the cubital fossa: 1. The basilic vein lies occupies a lateral position. 2. The cephalic vein accompanies the brachial artery above the cubital fossa. 3. Generally, the most prominent vein in the cubital fossa is the cephalic. 4. The aponeurosis of the biceps muscle is the non-vascular structure most commonly encountered at venepuncture. A: 1,2,3 Correct B: 1,3 Correct C: 2,4 Correct D: 4 Correct E: All Correct ABCDE Correct Answer: D At the cubital fossa, the veins of the upper limb are divided into deep and superficial. The deep brachial veins are arranged in pairs which accompany the brachial artery. They begin at

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the elbow by the union of the venae comitantes (companions) of the ulnar and radial arteries and end in the axillary vein. The brachial veins contain valves and are connected at intervals by short transverse branches. The superficial veins are the cephalic (medial) and basilic (lateral) veins. They are linked by the median cubital vein anterior to the bicipital aponeurosis. The latter vein is most commonly used for venepuncture, however, considerable anatomic variation exists. MOORE, K.L; Clinically Oriented Anatomy, Williams and Wilkins, 1982, pp 740-1. Number: 949 The pudendal nerve: 1. Crosses the greater sciatic foramen. 2. Crosses the lesser sciatic foramen. 3. Gives off the inferior rectal (inferior haemorrhoidal) nerve. 4. Gives off the posterior cutaneous nerve of the thigh. A: 1,2,3 Correct B: 1,3 Correct C: 2,4 Correct D: 4 Correct E: All Correct ABCDE Correct Answer: A See: "Anatomy for Anaesthetists" Ellis and Feldman ISBN 0865427216 According to these authors: "The pudendal nerve (S2, 3, 4) provides the principal innervation of the perineum; its course is complex, passing from the pelvis, briefly through the gluteal region, along the side-wall of the ischiorectal fossa and through the deep perineal pouch to end by supplying the skin of the external genitalia. Arising as the lower main division of the sacral plexus (although dwarfed by the giant sciatic nerve), the pudendal nerve leaves the pelvis through the greater sciatic foramen below piriformis. It appears briefly in the buttock region, accompanied laterally by the internal pudendal vessels, merely to cross the dorsurn of the ischial spine and straightway disappear through the lesser sciatic foramen into the perineum, The nerve now traverses the lateral wall of the ischiorectal fossa, accompanied by the internal pudendal vessels, and lies within a distinct fascial. compartment on the medial aspect of obturator internus termed the pudendal canal (Alcock's canal). Within the canal, it first gives off the inferior rectal nerve which crosses the fossa to innervate the external anal sphincter and the perianal skin, then divides into the perineal nerve and the dorsal nerve of the penis.

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The perineal nerve is the larger of the two. It bifurcates almost at once; its deeper branch enters the deep pouch and there supplies sphincter urethrae and the other muscles of the anterior perineum the ischio-cavernosus, bulbospongiosus and the superficial and deep transverse perinei. Its more superficial branch innervates the skin of the posterior aspect of the scrotum. The dorsal nerve of the penis (or clitoris) traverses the deep perineal pouch, pierces the perineal membrane near its apex, then penetrates the suspensory ligament of the penis to supply the dorsal aspect of this structure." The posterior cutaneous nerve of the thigh arises directly from the S1-3 roots of the sacral plexus. Number: 950 The sphenoplatine ganglion: 1. Receives parasympathetic inflow from the greater superficial petrosal nerve. 2. Provides secretomotor fibres to the lacrimal gland. 3. Receives sympathetic inflow via the deep petrosal nerve. 4. Provides parasympathetic supply to the pupillary sphincter. A: 1,2,3 Correct B: 1,3 Correct C: 2,4 Correct D: 4 Correct E: All Correct ABCDE Correct Answer: A See: "Anatomy for Anaesthetists" Ellis and Feldman ISBN 0865427216 According to these authors: "The sphenopalatine ganglion (which is associated closely with the maxillary nerve) is deeply placed in the upper part of the pterygopalatine fossa. It receives para-sympathetic, sympathetic and sensory nerve fibres. The parasympathetic component is derived from the greater superficial petrosal nerve which originates from the geniculate ganglion of the facial nerve (VII). This nerve traverses the petrous temporal bone then runs in a groove on the anterior surface of the bone deep to the trigeminal ganglion to enter the foramen lacerum. Here it is joined by the deep petrosal nerve to form the nerve of the pterygoid canal (the vidian nerve) which passes through the pterygoid canal to reach the sphenopalatine ganglion. These parasympathetic fibres, having arrived at the ganglion, have not completed their complicated journey. They are transmitted via the zygomaticotemporal branch of the

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maxillary nerve to the lacrimal branch of the ophthalmic nerve by which they arrive at their final destination as secretomotor fibres to the lacrimal gland. Sympathetic fibres, derived from the internal carotid plexus, form the deep petrosal nerve which, as described above, reaches the ganglion via the nerve of the pterygoid canal. The sensory component is derived from the two sphenopalatine branches of the maxillary nerve. The sensory and sympathetic (vasoconstrictor) branches of the ganglion are distributed to the nose, nasopharynx, palate and orbit via the following branches: (i) The long sphenopalatine nerve passes medially through the sphenopalatine foramen, crosses the roof of the nasal cavity, then passes downwards and forwards along the nasal septum, grooving the vomer as it does so, to reach the incisive foramen and thence the mucous membrane of the roof of the mouth. It supplies filaments to the posterior part of the nasal roof, to the nasal septum, and to those parts of the gums and anterior part of the hard palate which are in relation to the incisor teeth. (ii) The short sphenopalatine branches also pass medially through the sphenopalatine foramen; they supply sensory fibres to the superior and middle conchae and to the posterior part of the nasal septum. (iii) The greater palatine nerve descends through the greater palatine canal, then emerges on to the hard palate from the greater palatine foramen just posterior to the palatomaxillary suture. It innervates the mucosa of the gums and hard palate as far forward as the level of the canine teeth. Other fibres pass backwards to serve both aspects of the soft palate and nasal branches pierce openings in the perpendicular plate of the palatine bone to supply the region of the inferior nasal concha. (iv) The lesser palatine nerves, two or occasionally three in number, pass through the greater palatine canal in company with the greater palatine nerve but emerge through separate lesser palatine foramina, which perforate the inferior and medial aspects of the tubercle of the palatine bone. They supply the soft palate, uvula and tonsil. (v) The pharyngeal nerve passes backwards through the pharyngeal canal in the posterior wall of the pterygopalatine fossa to supply an area of nasopharyngeal mucosa immediately behind the orifice of the Eustachian tube. (vi) The orbital branches are small; they constitute two or three fine twigs which pass through the superior orbital fissure to supply the adjacent periosteum and perhaps also to carry some secretomotor fibres from the sphenopalatine ganglion to the lacrimal gland." The parasympathetic supply to the pupillary sphincter arises from the ciliary ganglion. Interest in this neurological backwater has recently been rekindled by pain doctors! See: Klein RN, Burk DT, Chase PF. Anatomically and physiologically based guidelines for use of the sphenopalatine ganglion block versus the stellate ganglion block to reduce atypical facial pain.

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Cranio. 2001 Jan;19(1):48-55. Cohen S, Trnovski S, Zada Y. A new interest in an old remedy for headache and backache for our obstetric patients: a sphenopalatine ganglion block. Anaesthesia. 2001 Jun;56(6):6067. Number: 983 The sphenoplatine ganglion: 1. Is situated in the pterygopalatine fossa. 2. Provides sensory innervation to the soft palate. 3. Receives sympathetic inflow via the deep petrosal nerve. 4. Provides sympathetic innervation of the nasopharynx. A: 1,2,3 Correct B: 1,3 Correct C: 2,4 Correct D: 4 Correct E: All Correct ABCDE Correct Answer: E See: "Anatomy for Anaesthetists" Ellis and Feldman ISBN 0865427216 According to these authors: "The sphenopalatine ganglion (which is associated closely with the maxillary nerve) is deeply placed in the upper part of the pterygopalatine fossa. It receives para-sympathetic, sympathetic and sensory nerve fibres. The parasympathetic component is derived from the greater superficial petrosal nerve which originates from t