Fawzia Sheet Anatomy Recalls with Explanations.pdf

For MRCS Part A
Study Note for candidates
Recall for Exam

1. MRCS Fawzia Sheet Recalls

E

ET

“The best antidote | know for worry is
work.

The best cure for weariness is the
challenge of helping someone who is
even more tired.

One ofthe great ironies of life is this:
He or she who serves almost always
benefits more than he or she whois
served.”

a

“No one has ever become poor by giving.”

y = >” prBishoy

Answered With Explanations
A E 7

2. A 37-year-old man presents with severe headache, photophobia arid neck stiffness.
Es: positive and a midline lumbar puncture is performed immediately to
determine if a cerebrospinal ia EEE; involved. In performing this procedure,
which is 'he first of the following structures to be pierced by the lumbar puncture needle?

B. Arachnoid mater

C. Dura mater
=

A. Anterior longitudinal ligament E

D us

" DoctorBishoy
E. Posterior longitudinal ligament

in Order from skin to inward
skin

supraspinus ligament
interspinus ligament
ligamentum flavum

3. 11. A 70-year-old woman from a nursing home presents to the! Emergency Department
with abdominal pain and vomiting. On examination, she is dehydrated and her abdomen is
distended. There is a 3 cm 4 cm swelling in her right groin which is non-tender, and there is
no cough ulse. At operation, a femoral Hernia found. Which of the following lies

A. Femoral artery
B. Femoral nerve
C. Femoral vein

E. Pectineal ligament

4. 12. A 26-year-old man presents to the Emergency Department with extensive bleeding
from his arm after sustaining a glass injury. On examination there is a 7 cm transverse
laceration across the anterior aspect of his elbow. On exploring the cubital fossa you would
expect the

A. anterior to the median nerve
B. lateral to the biceps tendon

D. medial to the median nerve
E. superficial to the bicipital aponeurosis

5. 15. A 45-year-old mart presents with backache and leg pain due to a prolapsed lumbar
Intervertebral disc. The pain, which is aggravated by coughing and i
the lateral aspect of the foot. On examination, there i:
the foot, which nerve rootis most likely to be involved?

A.T12
B.L4
et:

E52

6. 18. A 22-year-old man has been stabbed in the left fifth intercostal space at the edge of the

sternum. Which structure is most likely to have been penetrated?

ALeft atrium
B Left lobe of the liver
C Left ventricle

7. it is reduced in the Emergency Department.

19. An 80-year-old man
e abduction of his arm. Which

At review three weeks later, he is u
muscle most likely damaged?

A Clavicular head oi pectoralis major

an

D Teres major

DoctorBishoy

initiation up to 15 = supraspinatus

15-90 = deltoid
90 and above = trapezius + seratous anterior

8. 24. A 42-year-old multiparous woman is admitted to the Emergency Department due to
pelvic discomfort. The duty gynecologist diagnoses 2 apse. Which anatomical
structure gives significant d

A. Cervical ligaments
B. Mesometrial part of the broad ligament
C Mesosalpingial part of the broad ligament

D. Round ligaments

9. 29. Which one of me following muscles is an extensor of the hip?

A. Adductor longus
B. Gracilis

C. lliopsoas

D. Pectineus

10. 31. A 65-year-old man presents with haematuria and left loin pain. Computerised

tomography demonstrates a left renal tumour. He undergoes a left radical nephrectomy.
Where does the left renal artery ie?

A. Anterior to the left gonadal vein
B Anterior to the left renal vein
terior to the splenic vein

tath

DoctorBishoy

remember it croses in front of the aorta and below SMA

11. 32. Within the posterior triangle, which nerve is at particular risk of damage during
surgery?

A. Auricular branch of the facial

B Glossopharyngeal

C Phrenic

D Recurrent laryngeal

12. 33. The right and le: are derived from which of the following
embryological

A Second aortic arch
B Third aortic arch

C Fourth aortic arch
D fifth aortic arch’

13. 35. During arch aortography, the vertebral artery would be seen to arise directly from
which of the following?

A. Arch of the aorta

B Brachiocephalic artery

€ Common carotid artery

D Internal carotid artery

14. 35. During arch aortography, the vertebral artery would be seen to arise directly from
which of the following?

A. Arch of the aorta

B Brachiocephalic artery

€ Common carotid artery

Internal carotid artery

DoctorBishoy

Subclavian artery is a little bit important, why ?
Because it Supplies :

Thyroid

Breast

Diaphragm

Brain stem

And upper limb

15. 37. A 3-year-old boy is admitted to hospital with severe vomiting. Radiographic
examination reveals that he is suffering from
is constricted?

Which of these structures

d part of duodenum
D Proximal jejunum
E Pylorus of stomach

16. 39. A 36-year-old man presents with a two-month history of low back pain radiating Ha his

left leg After clinical examination he is referred for an MRI scan. This shows a
The clinical signs are consistent with

combination of clinical signs is most likely?

Weak ankle plantarfiexio

C Weak hallux dorsiflexion; altered sensation on the anterior surface of the leg; loss-of ankle jerk reflex.
D. Weak hallux dorsiflexion; alter
E. Weak hallux dorsiflexion; altere] DoctorBishoy

The Trick here is to look for Ankle Reflex loss and

sensory loss of s1 root = lateral foot & sole

17. 43. A surgeon makes a Pfannenstiel incision for access to the pelvic organs. He incises

theabdominal wall down to and through the rectus sheath.-He retracts the rectus
om the midline

A. linea alba

B. peritoneum

C. posterior rectus sheath

E. transversus abdominis muscle

18. 49. A 65-year-old man presents with vomiting and .weight loss. On examination he had 3
palpable epigastric mass. The 1e lies at which; vertebral level?

ATıı

Re

D
E DoctorBishoy

L1 =

Pylorus

Neck of pancreaus
SMA

Gall bladder fundus
kidney hilum

2nd part of dudenum
dudenojujenal flexure
transverse colon

End of spinal cord

19. E ituation what is the most appropriate surgical method of obtaining

A Cutting and retracting the cricothyroid muscle
B Cutting the thyrohyoid membrane .
C Dividing the thyroid isthmus

ntering the trachea at the C7 level

DoctorBishoy

cricothyrodotomy

20. 52. A75-year-old man presents with hepatomegaly and ascites. Computerised

tomography shows evidence of post hepatic portal hypertension. The inferior vena cava:
ass trough the iphragm we vertebral eve

B.T9

a
p DoctorBishoy
E

IVC T8 - bifuraction T5
esophagus 4 constrictions diaphragm T10
Aorta T12 bifurcation T4

21. 62. A 2-year-old child is referred because of an impalpable testis in the left scrotum. Which
of the following positions describes an
A At the deep inguinal ring

C At the superficial inguinal ring
D In the inguinal canal.
E in the upper part of the scrotum

22. 65. An 82-year-old man has complete occlusion of his inferior mesenteric artery on

angiography but no symptoms or signs of colonic ischemia. Which of the following arteries
is the most likel

A Left colic

a eft gastroepiploic

D Splenic
E Superior rectal

23. 69. A 35-year-old man is admitted to hospital with vomiting, nausea and severe
headaches. An MRI scan reveals a tumour of the cerebellopontine angle. Which one of the
following pairs of cranial nerves is most likely to be compressed by this tumour?

A Accessory and vagus

acial and vagus

D Glossopharyngeal and vestibulocochlear

DoctorBishoy

2244
cerebral 2 (1,2 )

midbrain 2 (3,4)
pons 4 (5,6,7,8)
medulla 4 ( 9,10,11,12 )

24. Which of

70. After resection of d rectal tumour a patient experience
the following nerves is most likely to have been damaged in surgery?

A Genitofemoral nerve
umbosacral plexus

DoctorBishoy

Nervi ergintis

25. 72. A 22-year-old man arrives to the Emergency Department with sudden breath less ness
due to a large pneumothorax. A chest drain is inserted into the fifth left intercostal space
in 5% mid-axillary line. There is haemo! into the drainage bottle. Which of the
following structures is the most likely e this acute haemo

B Left pericardiophrenic artery
€ Lingula of the lung

D Right ventricle of the heart
E Spleen

26. 76. In order to expose the right axillary artery, a transverse skin incision is typically made
below the clavicle from a point just lateral to the sternal end of the clavicle to the

ve. Which of the following structures would be encountered in the

n down to the vessel?

dissec

A Lateral thoracic artery
B Phrenic nerve

C Suprascapular artery
D Thoracic duct

27. 77- Ay-year-old boy presents to the E

g and drowsiness. A

rgency Department with a two-day history of

B Infundibular recess

C Interventricular foramen (of Monro)

D Lateral foramen of fourth ventricle (foramen of Luschka)

E Median foramen of fourth ventricle (foramen of Magendie)

28. 80. A 56-year-old man with chronic emphysema is on the high dependency unit (HDU), ten
days after anterior resection. He has developed acute shortness of breath' and
hypotension): Which of the following sndiaalds would be the most appropriate to use to

A. A point midway between the anterior superior iliac spine and the pubic tubercle

C. A point midway between the greater trochanter and the pubic symphysis
D. A point 1 cm inferior and 4 cm lateral to the pubic tubercle

E. A point 2 cm lateral to the midway point between the anterior superior iliac spine and
pubic symphysis

29. 81. A 70-year-old man complains of persistent numbness since.an inguinal hernia repair
one year previously. Th
small area below the medial part of the inguinal ligament. Which nerve is likely to have
been damaged?

A. Femoral branch of the genitofemoral nerve

B. Genital branch of the genitofemoral nerve

C. lliohypogastric nerve

E. Medial cutaneous branch of the femoral nerve

30. 82. A 12-year-old girl has a diastolic murmur. It is maximally audible in the second left
intercostal space. Pathology of which structure is the most likely cause?
A. Aortic valve

B. Ductus arteriosus
€. Mitral valve

E. Tricuspid valve

31. 87. A 60-year-old man undergoes cystectomy for a bladder carcinom , the
ureters are identified. On which region of the bladder do the
wall?

A. Anterior surface

B Apex

C Lateral surfaces

D,Neck

DoctorBishoy

A very famous Recall Anatomy Question
yet does come with many answsers

if you found Base in the options choose it
if not go for posterior like here

32. 88. A year-old patient in the intensive care unit has a performed via the
second, third and fourth tracheal rings. Which intervening structure is most likely to

A Anterior jugular vein
B Inferior thyroid veins
€ Sternothyroid muscle
D Thymus

33. 89. A 23-year old man is assaulted and sustains a stabbing injury to the left groin. The

wound- is cleaned and a simple dressing applied; Six months later the patient returns with
at a Tho most probable:

lesion present is:

A Abscess

C Lymphocoele
D Mycotic aneurysm of the femoral artery
E. Saphena varix

34. 91. A 16-year-old boy is hit on the left side of the face by a ball. There are no broken bones
but the boy complains AE EEE ROAR. Which nerve has most likely
been compromised?

A Abducens nerve.

B Facial nerve
C Glossopharyngeal nerve .

E Zygomatic nerve

35. 94. After reve an intermascular Injection i in the buttock, a 25 year-old man complains
Which nerve is most likely to have been injured?

B Inferior gluteal

€ Pudendal =
D Superior gluteal Dee
E.libialcompenentofsciatie Evertion of the foot is specifically the lateral

compartment action ( Pernoneus Longus & brevis ) via
superficial peroneal nerve

36. 98. A 36-year-old man falls on his outstretched right hand. Examination reveals
tenderness in the anatomical snuff box. Which one of the following tendons form a

A Abductor pollicis brevis

B Extensor carpi radialis brevis
€ Extensor carpi radialis longus
Extensor indici:

DoctorBishoy

Forms medial boundry of the snuff box

37. de A a man RER with back ache. Neurological examination reveals lack of

i Which of the following spinal cord segments are likely to
be involved?
A Li, L2 8: L3

BL2,L3&L4
Ei

DS1, $2, & 53
E S3, 54 8: S5

38. 103. A 34-year-old man is seen in the Emergency Department with
following football match. On examination he is noted to have Which
area ee loss of the cutaneous distribution of the

affected-nerve?

A. Along the lateral aspect of the foot
2, Along the medial aspect of the foot

D. On the plantar Surface of the foot

E. Over the heel
DoctorBishoy

it's the anterior part which you can see with your eye

when you look at it
yes it's not the sole :)

39. 110. A 10-year-old child presents with progressive facial weakness and a squint. On
examination there is a lower motor neuron facial weakness and failure of abduction of one
eye. An MRI scan shows a small, intrinsic mass lesion within the central nervous system.

A The cerebellar vermis
B The cerebellar tonsil
C The medulla

oe midbrain

DoctorBishoy

2244
Cerebrum 2

mid brain 2
pons 4
medulla 4

40. 116.A aa man a of recent onset diplopia. On examination he is unable to

ith his right eye; The most likely diagnosis is a lesion ofthe?

A. abducens nerve
B. ciliary ganglion

C. nasociliary nerve
D. oculomotor nerve

41. 127. A 66-year-old woman with known tumour of her spine has started to retain urine and
a tumour is pressing directly on the

At which one of the following vertebral levels is the tumour most likely
to be located?

A. T9/T10
BT11/T12

DL3/C4
EL5/S1

42. 129. A 50-year-old woman presents with a history over the past few
year She had a prolonged and difficult first stage of labor 20 years previously. Physical
examination reveals a relatively lax anal sphincter. Which nerve is likely to have been
damaged in labour?

A Autonomic nerves to the rectum
B Genitofemoral nerve

C Lumbosacral trunk

Obturator nerve

DoctorBishoy

remember it's responsible for incontence but not
erection which was nervi ergintis splanchnic nerves

43. 134. A 4-year-old boy, is brought to the Emergency Department with a painful right elbow.
His father stales that he was swinging his son by his arms when the pain came on suddenly
An X-ray shows that the radial head is displaced from its usual position. What is the

ligament (of the proximal radio-ulnar joint) that holds the radial head in place?

B Conoid ligament

C Quadrate ligament
D Radial ligament

E Ulnar ligament

44. 135. A 35-year-old man presents with a three-week history of low back pain and a three-
day history of pain and weakness in his left leg. Physical examination demonstrates
numbness over the posterior aspect of the left calf extending to the lateral aspect of th
foot. Left ankle reflex is absent. A magnetic resonance scan show:
Sir t. What is the most likely responsible structure?

A. Annulus fibrosus
B. Anterior longitudinal ligament

D. posterior longitudinal ligament
E. Vertebral end plate

45. 5. A32-years old man presents with a painful torticollis there is no past medical history and
his only complaint is that he has been feeling rather tired over the last 4 nights. On
examination, he has large rubbery mass in the lateral aspect of his neck as well as a few
smaller masses along his internal jugular vein. You correctly assume that the muscular

neck ea and the large mass are connected.

A. Ansa cervicalis
B. Cervical plexus branch
Cranial accessory nerve

nerve supply of Trapezius & Sternomastoid

E. Vagus nerve

46. 12. A 34-year-oid man is admitted to-the Emergency Department with a On
examination hi: ACT scan of the brain demonstrates a

Which of the following arteries is the most likely source of this?
A. Anterior cerebral

B. Middle cerebral Very common recall Question

it's branch from maxillary artery which is from
the external carotid not the internal carotid

D Posterior cerebral
H. Superficial temporal

47. 13. A 65-year-old man has a history of transient ischemic attacks. He is due to undergo
carotid endarterectomy. Which one of the following E
A. Begins at the level of the sixth cervical vertebra

B. Divides into the anterior, middle and posterior cerebral arteries

D. Is accompanied within the skull by preganglionic sympathetic nerves
E. Passes through the foramen ovale

Ophthalmic artery :

Begins at C3 when CCA bifurcates

enters through carotid canal in forumen lacerum ends in the circle of willis
separated from external carotid by styloid process

Branches :

1. Ophthalmic artery

2. Ant & Middle cerebral arteries

3. Posterior communicating & Anterior Choroid arteries 5

48. 15. A 26-year-oJd man presents to the Emergency Department after sustaining a glass
cut to his arm. On examination there is a 10 cm longitudinal laceration on the

anterior aspect of his upper arm. He has symptoms suggestive of ulnar nerve injury.
On exploring the upper part of the arm we would expect the

A. anterior then medial to the brachial artery
B. medial then anterior to the brachial artery

D. posterior then medial to the brachial artery
E. posterior to the brachial artery

49. 16. A 55-year-old man presents with acute back pain following a severe road traffic
accident. Neurological examination reveals
below. What is the spinal level of th

AT8
BT9
DTa
ERA

50. 19. A 60-year»old man presents to the-Emergency Department with epistaxis. The source
of the bleeding is identified a: and resolves with direct cautery. Which vessel is
most likely responsible for the bleeding?

A. Anterior ethmoidal artery
B. Infraorbital artery
C. Middle meningeal artery

E. Supratrochlear artery

Kiesselbach's area, or Kiesselbach's triangle.
The arteries are: 4
Anterior ethmoidal artery (branch of the ophthalmic artery)
Sphenopalatine artery (terminal branch of the maxillary artery)
Greater palatine artery (from the maxillary artery)
Septal branch of the superior labial artery (from the facial artery)

51. 20. A 75-year-old man presents with Sl reflux. A ÉLUS the
Presence of a hiatus hernia. The esop ‘ough
level?

AT8

Emo

DTi1

DoctorBishoy

T8 = IVC + Right Pherenic nerve
T10 = esophagus + Both Vagii
T12 = Aorta + azygous + thoracic duct

52. 22, A26-year-old man is having a stereotactic frame fitted to his skull prior to

radiosurgery on a cerebral arteriovenous malformation. Four pins secure the frame
tightly through the scalp to the outer table of the skull, two anteriorly, two
posteriorly. On insertion of one of the. 3
Which artery is most likely to have been punctured?

A The ascending pharyngeal artery
B The middle meningeal artery

D The posterior cerebral artery
E The posterior communicating artery

53. 24- A2 day old baby presents with increasing respiratory distress. He was born at term

By normal vaginal delivery. On examination he has ind marked
respiratory in drawing of the chest His t and he has been anuric
for the last 2 hours. Pulse rate is 140 beats/minute, regular, and his blood pressure is 60/30 mmhg
in both upper limbs. What is the most likely diagnosis?

A. Hypoplastic left heart syndrome

C. Pulmonary atresia and ventricular septal defect a
D. Transposition of the great arteries
E. Tricuspid atresia

Tetralogy of Fallot (TOF) is a congenital heart defect with four components:

1) large ventricular septal defect (VSD), which is a hole between the two ventricles or pumping
chambers in the heart;

2) pulmonary stenosis, which is narrowing beneath or in the blood vessel leading to the lungs;

3) overriding of the aorta, in which the aorta lies directly above the ventricular septal defect; and
4) as a result of these events, the right ventricle becomes thickened or hypertrophied.

54. 28. A 45-year-old man presented with backache and leg pain due to -prolapsed lumbar +
intervertebral' disc. The pain, which is a ing;
to the dorsum of the foot On examinatio
‘the foot. Which nerve root is most likely to be involved?

Aca

8-L3

C.Ls L5 is the Correct Answer
XD. Sa.

EB; S2

55. 29. A 75-year-old woman, who has a carcinoma of the upper rectum, undergoes
anterior resection. The arterial arises from which
of the following?

A. Coeliac artery
B. lliocolic artery
D. Internal iliac artery
E. Superior mesenteric artery
The rectum receives arterial supply through three main arteries: Superior rectal artery —

terminal continuation of the inferior mesenteric artery. Middle rectal artery — branch of the
internal iliac artery. Inferior rectal artery — branch of the internal pudendal artery.

56. 30. A 65-year-old man is undergoing an abdominal aortogram, A stenosis is
demonstrated in a lateral aortic branch, arising at the level of the body of the second

lumbar vertebra. The stenosed vessel is most likely to be the:

A. coeliac artery T12 = Celiac +inf phrenic + 1st lumbar
Li = Superior mesenteric + Renals L1/L2
there is a controsversry around this Q
L2 = 2nd Lumbar + gonadal arteries
D. seconc - umbar artery 13 = IMA

E. superior mesenteric artery L4= bifurcates

B. inferior mesenteric artery
C. left renal artery
=

57. 32. A 19-year-old woman presents to the Emergency .Department profoundly
hypovolemic having fallen from a horse. A postero-anterior (PA) chest radiograph
icle. Which of the following

A Brachiocephalic trunk
B Left axillary artery
C Left common carotid artery

E Left vertebral artery

58. 33- 65 years old man presented with an inguino-scrotal swelling in the right groin which is
non tender. A cough impulses i is elicited, At operation, an indirect inguinal hernia is
repaired. The crema: le is derived from which of the following

A. External oblique aponeurosis

€. Rectus abdaminis muscle
D. Rectus sheath
E. Trsusversalis fascia

59. 35. A 28-year-old man presents with pain in his left scrotum. A diagnosis of TESA
is made. Which vessel is involved?

A Femoral vein
E. Inferior epigastric vein
C. Long saphenous vein any young patient with varicocele do us to exclude

RCC occluding the renal vein Fingers Like Projections

D Internal pudendal vein

60. 38. an presents with a non-tender swelling in the right hemi-scrotum. At
operation, the ac is opened and 400 ml of fluid is drained. Which
anatomical structure surrounds the fluid?

A. Dartos muscle
B. Patent processus vaginalis
C. Testicular capsule

D. Tunica albuginea

Processus vagina
but an old man definitly in tunica vaginalis the hydrocele will accumulate

61. 39. A 24 years old man is brought to the Emergency Department following a road traffic
accident. He has obvious airway compromise due to mouth/ facial haemorrhage
which requires a a surgical airway. The surface landmarks used to localise, the optimal

the following? o

B Hyoid

C Mastoid
as o

E Thyroid

62. 39. A 24 years old man is brought to the Emergency Department following a road traffic
accident. He has obvious airway compromise due to mouth/ facial haemorrhage

which requires a surgical airway. The surface landmarks used to localise, the optimal
site for a tracheostomy incsion are midway between the suprasternal notchiand which of

the following?

B Hyoid
C Mastoid
D Laryngeal prominence
E Thyroid

( very common recall )

in tracheostomy we do cut the thyroid tel

63. 41. A 20-years man presents to the Emergency Department after accidentally tripping
over and lacerating his hand on a glass bottle. On examination there is a 2 cm
laceration on the hypothenar eminence with

| joi r. What is the most likely tendon to be injured?

A Flexor digiti minimi brevis

ndus
C Flexor digitorum superficialis
D Fourth palmar interosseous
E Lumbirical

DoctorBishoy

Take care is he asking about Distal or Proimal Don't slip
in this Trap

Proximal by Superficial

Distal by Profundus

64. 42 A75-year-old man, who smokes A
six x months 200 ‚Ale eft inte

underwent coronary artery bypass grafting
1 e aft was used. He now complains

E onthe m line to dry. Which of the following
lesions best ne his symptoms?

A. .Micro-emboli from the left common carotid artery

B. Micro-emboli from the le\t internal carotid artery

C. Stenosis.of the subclavian artery at the level of the costo-cervical trunk

D. Stenosis of the subclavian artery distal to the insertion of scalenus anterior

65. 45. A Bo yaarcid alcohglic man present co the Emergency Department and is found to

Heis also found

Which nerve is most likely to have been injured?:

A Median nerve
B Musculocutaneous nerve
C Posterior interosseous nerve

B. Ulnar nerve

66. 44. A 55 year-old man presents with acute back pain following a severe road traffic
accident. Neurological examination reveals lack of dorsi-flexion of the left ankle
joint. Which of the following spinal cord, segments are most likely to be injured?

A. Li, L2&L3 DoctorBishoy

L2,L3&L
Sues Femoral & Obturator : L2,3,4
D. S1, 52& 53 Pudendal : S2,3,4

Sciatic & Tibial : L4,5,51,2,3
Common Peroneal: L4,5,51,2
Superficial Peroneal : L4,5,S1
Deep Peroneal : L4,L5

67. 46. A 21-year-old man has been stabbed in the back of the knee, dividing the popliteal
artery, and is undergoing repair via a posterior approach. Which of the followin
structures is most likely to be encountered first, en SERRES.
incision?

A Popliteal artery

B Popliteus muscle

C Popliteal vein

E Soleus muscle

68. 47. A 78-year-old woman presents with urinary urgency and incontinence. The external
urethral sphincter is innervated by which of the following nerve roots?

A.L3485 DoctorBishoy

B. L4, 5 & SI

C.L5,51& 2 Femoral & Obturator : L2,3,4
D.51,2&3 Pudendal : S2,3,4

Sciatic & Tibial : L4,5,51,2,3
Common Peroneal: L4,5,51,2
Superficial fibular : L4,5,51
Deep Fibular : L4,L5

69. 49. A 19-year-old man was assaulted and sustained injuries to the right side of his head.
After two weeks he notices dial his right eye is dry and it could not produce tears.
from which ganglion is post synaptic fibers arise to

A. Geniculate ganglion
B. Inferior ganglion of the vagus nerve
es Suc ganglion Lacrimal Gland Peterggopalatine Ganglion
While the Parotid is Otic Ganglion

DoctorBishoy

E. Superior cervical ganglion

70. 50. A 35-year-old man undergoes a right inguinal hernia repair under genera! anaesthetic

as a day patient. He has a nerve block after the procedure. On recovery he has
eee ESR which nerve has been affected?

B. Genitofemoral nerve

Cllioinguinal nerve
D Estero cutaneous nerve Very Tricky Question yet it's a very common reall
E Sciatic nerve

Injury to the nerves after inguinal hernia surgery is uncommon. The femoral nerve may be
damaged by suture or staples, tissue scar entrapment, local anesthesia blockade or direct
compression. We present a case of a transient lesion of the femoral nerve after mesh
hernioplasty for a re-recurrent inguinal hernia, confirmed by radiolo: | studies,

electrophysiology and clinical recovery. The diagnosis, mechanism of injury and surgical
approach are reviewed. Surgery to a recurrent hernia may be underestimated. The role of
electromyography nerve conducting studies is emphasized insisting on the importance of
clinical evolution for the successful management of these infrequent injuries.

71. 51. Aman suffers a brachial plexus injury. On examination, he has a
in association with upper limb paralysis. Which nerve roots does the Homer's
syndrome suggest involvement of?

A. C2 8: C3 roots
B. C4 8: C5 roots
C. C6 & C7 roots

E. T2 8: T3 roots

72. 52. A 60-year-old woman with breast carcinoma complains of difficulty chewing her. .
food and is found to have nu: CT scanning shows
a small metastatic lesion affecting the bony skull base on. The same side as the lip
numbness. Which foramen is the most likely to involve?

A. Foramen caecum
B,Foramen magnum Mandibular branch of the Trigeminal nerve CN V
C ora y

. Foramen rotundum
. Foramen spinosum

D

m

73. 53. Which one of the following muscles is an ext

A. Adductor longus
B. Gracilis
C. lliopsoas

D. Pectineus

74. 54. In order to expose the right axillary artery, a transverse skin incision is typically
made below the clavicle from a point just lateral- to the sternal end of the clavicle to
the deltopectoral groove. Which of the following structures would be encountered in
the dissection down to the vessel?

. Lateral thoracic artery
. Phrenic nerve

A
B
C. Suprascapular artery
D. Thoracic duct

75. 56. In the posterolateral approach to a posterior malleolar fracture, an incision is made
between the calcaneal (Achilles) tendon and the distal-.fibula. Which of the following
structures is at risk?

A. Deep peroneal (fibular) nerve

B. Saphenous nerve
C. Superficial peroneal, (fibular) nerve

E. Tibial nerve

76. or
Diathermy is applied to a neural structure

b. What is the most likely complication

treatment of righ

to occur as a result of this procedure?

A. Bradycardia DoctorBishoy
B. Hoarseness

Sympathetic is running near the neck of the first rib so

D. Raised right hemi diaphragm similar to the concept of pancoast tumor

E. Reduced right biceps tendon reflex

77. 58 / A 33-year-old man presents to the orthopedic outpatient clinic with a six-month
history of low back pain radiating to the lateral aspect of the left upper thigh. Micturition
and defecation are normal and there is no history of previous Injury. On examination, left
lateral flexion of the spine is limited but a full range of hip movemen:
although it is painful. Sensation is altered over the front of the kne:
‘reduced. Which spinal nerve-is most likely to have been compressed?

A. Li
B.L2
CB
D.L4
E.L5

78. 60. On-an ultrasound scan of the popliteal fossa when investigating-a swelling, which of
the following structures is closest to the capsule of the knee joint?

A Great (long) saphenous vein

C Popliteal vein

D. Small (short) saphenous vein
E. Tibial nerve

79. 61.A 25 years old man sustains a twisting injury while playing football. He develops
aeg of the knee and he can not continue the game. Six months later,

he Is still not able to play football. His knee feels unsteady and
examination, he has afullange af knee motion, There

test and a small effusion. What is the most likely structure damaged?

anterior draw = ACL

B. Lateral collateral ligament posterior draw = PCL

C. Medial collateral ligament - valgus = MCL
D. Oblique popliteal ligament Varus = LCL
E. Posterior cruciate ligament

80. 66. A 60-year-old man undergoes cystectomy a bladder carcinoma. During surgery,
the ureters are identified. On which region of the bladder do the ureters pierce the
bladder wall?

A. Anterior surface
B. Apex
C. Lateral surfaces

81. 68. A 28-year-old man presents with an ischiorectal abscess. Where is ths abscess
cavity likely to be sited?

A. Above the levator ani

B. Between external and internal anal sphincter
€. Lateral to the obturator internus

D Medial to the internal anal-sphincter

82. 69. A 36-year-pld man falls on his outstretched right hand.-Examination reveals «
tenderness in the anatomical snuffbox. Which one of the following tendons form a
boundary of the anatomical snuff box?

A. Abductor pollicus brevis .

B Extensor carpi radialis brevis
C. Extensor cairpi radialis longus
D. Extensor indicis

83. 71. A 40-year-old. woman presents with faecal incontinence and; anatomically intact
internal and external anal- sphincters. Which structure is most likely to have been
damaged?

A. First sacral nerve-root
B. Obturator nerve:
€. Pelvic splanchnic nerves

D. perineal nerve

84. 72. Abdominal free fluid will collect in the lowest part of the peritoneal cavity. At
operation with the patient supine, in which of the following will the fluid collect first?

B. Left subphrenic space
C. Lesser sac

D. Right paracolic gutter
E. Right subphrenic space

85. 77. A 3-year-old boy is admitted to hospital with severe vomiting. RGO DRE
examination and history reveals that he is suffering from
these structures is constricted?

First part of duodenum

C. Third part of duodenum
D. Proximal jejunum
E. Pylorus of stomach

86. 78. A 45 year-old man presents with a 3 cm * 4 cm swelling in the right groin which is
non-tender. A cough impulse is elicited. At operation, an indirect inguinal hernia is
found. The EG SE AGE SATE

ofthe following abdominal

B. External oblique muscle
C. Internal oblique muscle

D Transversus abdominis muscle
E Transversalis fascia

87. 80. A 23-year-old man presents to the Emergency Department-with non-specific: chest

ains. A postero-anterior (PA) chest radiograph is performed and is normal. Immediately
Inferior cavidal to the outline ofthe aortic knckle was afarther structure wth a convex

border. What is this structure?
A. The left atrium
C. The oesophagus

D. The right atrium
E. The superior vena cava

88. 82. An 82-year-old man has complete occlusion of his inferior mesenteric artery on

angiography but no symptoms or .signs of colonic ischaemia. Which of the following
arteries is the .most likel

A Left colic artery

B Left av,

D. Splenic
E. Superior rectal

89. 84. A 35-year-old man presents with a three-week history of low back pain and a three day
history of pain and weakness in his left leg. Physical examination demonstrates numbness
over the posterior aspect of the left calf extending to the lateral aspect, of the foot. Left
ankle reflex is absent. A magnetic resonance scan shows compression of the left Sı. nerve
root. What is the most likely structure compressing the nerve?

A. Annulus fibrosus
B Anterior longitudinal ligament

D. posterior longitudinal ligament
E Vertebral end plate

90. go. A 70-year-old man undergoes transurethral resection of E O
tumour lies over the lateral side wall of the bladder just above the opening forthe right
ureteric orifice. Use of the diathermy suddenly causes the patient to 'kick' because of
contraction of the hip adductors muscles. Which nerve has been stimulated?

A Femoral nerve
B Genitofemoral nerve
C Lateral femoral cutaneous nerve

E Sciatic nerve

91. 93. A 25-year-oid man is playing football when he complains of posterior thigh pain whilst
sprinting with the ball. On examination he has tenderness in the lo
thigh. He is unable to fully extend the knee due to pain. What is the most likely injury?

B. Gracilis tear
C. Gastrocnemius tear
D. Semimembranosus tear
E Semiteodinosus tear

92. 94 - A 23 years old man is assaulted and sustains a stab injury to the left groin. The wound
is cleaned and a simple dressing applied. Six months later the patient returns-
with a pulsatile swelling in the site of the injury. The most probable lesion present is:

A. Abscess

C. lymphocele
D. mycotic aneurysm of the femoral artery
E Saphena varix

93. 95. 12 years old girl has a diastolic murmur it is maximally audible in the 2" left intercostal
space. Pathology of which structure is the most likely cause ?

A. Aortic valve

B. Ductus arteriosus

C Mitral valve

E. Tricuspid valve

94. 98. A 21-year-old map comes into the Emergency Department with a severe headache
and neck stiffness of recent onset. You suspect acute meningitis and decide immediately
to treat with antibiotics and perform a lumbar puncture. After your third attempt to obtain

for cerebrospinal fluid (CSF) you notice that the fluid obtained is stained red. However
| y i into three containers it is noted that the final bottle is now

A.. Anterior spinal artery

B. Epidural artery

C. Subarachnoid vein

D. Veins within the erector spinae muscles
JS

95. 104. A 29 year old pregnant woman is having uncontrolled labor pains. She has an
epidural for pain reli "Which of the folowing is true

A. An epidural puncture should only be performed below the L1 level to avoid damage to the spinal cord
B. An epidural puncture should only be performed below the L4 level to avoid the spinal cord

D. The liganientum flavum is rarely pierced during a low epidural procedure
E. The supraspinous and interspinous ligaments are rarely pierced during the procedure .

96. 107. PAGEL recovery from varicose veins surgery 35 years old woman complains of
e ankle Physical examination reveals
Which of the following nerves is most likely

DoctorBishoy

B. Deep peroneal nerve
C. Saphenous nerve Loss of Motor action of Deep peroneal Nerve & Sensory

D. Superficial peroneal nei Supply of Superficial Nerve = Common Peroneal Nerve
E. Sural nerve I

97. 109. A 19-year-old man fell down a flight of stairs. On presentation to the Emergency
Department his Glasgow coma scale (GCS) was 14/15 with no focal neurological signs. An
hour later he vomited and his GCS deteriorated to 10. He developed a
pupil-. Which of the following accounts for the pupillary signs?

o p DoctorBishoy
B. Compression of sympathetic fibres to the left iris
C. Compression of the afferent fibres in the left optic nerve ParaSympathetic Nerve = 1973
D. Compression of the Edinger Westphal nucleus Occulomotor (3)

E. Compression of the optic chiasma

Sympathetic dilate

Parasympathetic constricts

When one is damaged the other dominates
When Parasympathetic damaged no constriction
Sympathetic dilatation dominate

98. 110. À 32-year-oid mountain biker presents to the butpatient clinic. He fell awkwardly,
with excessive lateral flexion of his neck to the left side. He describes some paresthesia

over his right shoulder and lateral arm. Which appears to have been improving over the
past hour. What is the most likely injury suggested by this history?

A. Axonotmesis of the C5 nerve root
B. Axonotmesis of the T1 nerve root

D. Neuropraxia of the T1 nerve root
E. Neurotmesis of the C5 nerve foot

99. 110. A 32-year-oid mountain biker presents to the outpatient clinic. He fell awkwardly,
over hi Which appears t: ver the
past hour. What is the most likely injury suggested by this history?

A. Axonotmesis of the C5 nerve root
B. Axonotmesis of the T1 nerve root

D. Neuropraxia of the T1 nerve root
E. Neurotmesis of the C5 nerve foot

100. 113. A 26-year-old man presents to the Emergency Department with extensive bleeding
from his arm, after sustaining a glass injury.-On examination- there is n 7 cm transverse
laceration across tire anterior aspect of his elbow. On exploring the cubital fossa, you

would expect thi

A. anterior to the median nerve
B. lateral to the biceps tendon.

D. medial to the median nerve
E. superficial to the bicipital aponeurosis

101. 112. A 50-year-old woman presents with a history o

he had a prolonged and difficult first stage of labour 20 years previously. Physical
examination reveals a relatively lax anal sphincter. Which nerve is likely to have been
damaged in labour?

A. Autonomic! nerves to the rectum.
B. Genitofemoral nerve
C. Lumbosacral trunk

D. Obturator nerve

102. 115. A 58-year-old woman, a known patient with thoracic right-sided meningioma,
presents with features suggestive of a The clinical,
findings will include which of the following?

A Left sided weakness, left sided proprioception and vibration loss, right sided loss of pin prick
sensation

C Right sided weakness, right sided proprioception and vibration loss, right sided loss of pin prick
sensation

D. Right sided weakness, left sided proprioception and vibration loss, right sided

loss of pin prick sensation

E. left sided weakness, right sided proprioception and vibration loss, left sided loss of pin prick
sensation.

103. 121. A 22-year-old men arrives in the Emergency Department with sudden breathlessness
due to a large pneumothorax. An immediate ches s into the fifth left
intercostal space in the mid-axillary line, Ed ish E

Which of the following structures is the most likely

elof this acute hemorrhage ?

B. Left pericardiophrenic artery
€. Linguia of the lung

D. Right ventricle of the heart
E. Spleen

104. 122. The right and left pulmonary arteries are derived from which of the following
embryological aortic arches?

A. Second aortic arch
B. Third.aortic arch
C. Fourth aortic arch
D. Fifth aortic arch

105. 123. In the fetal circulation, the majority of blood passing from the inferior vena cava
into tire right atrium subsequently passes next into which; one of the following?

E m
C. left ventricle

D. pulmonary artery
E. Right ventricle

106. 124. A 36-year-oid butcher injures his left index finger with a knife, suffering a deep
laceration on the palmar aspect of the middle phalanx. On examination he is unable to flex
DIP, which tendon is likely to have been injured?

A. flexor carpi facialis
B. flexor carpi ulnaris

D. Flexor digitorum superficialis
E. Flexor indicis

107. A 39-year-old woman with large, expanding ovarian mass that is removed surgically,
requiring a lateral pelvic wall clearance, of lymph nodes. Four days postoperatively she
complains of painful spasms in the groin area and remarks that she has an area of
numbness on the The most likely explanation for these, problems
is that during surgery an injury was inflicted on the:

A. femoral nerve

B. genitofemoral nerve
C. lumbosacral trunk
D. L3 ventral ramus

108. 127. À .surgeon is carrying out an elective splenectomy for congenital spherocytosis.

A. Gastrosplenic ligament
B. Lesser omentum

D. phrenicocolic ligament
E. Short gastric vessels

109. 131. After resection of a rectal tumour a patient experiences erectile dysfunction. Which
of the following nerves is most likely to have been damaged in surgery?

A. Genitofemoral nerve DoctorBishoy
B, Lumbosacral, plexus

nervi erjentis is in close proximity to rectum = Pelvic

D. Perinea! branch of 54 splanchnic nerves
E. Pudendal nerve

110. 4. A 30-year-old man is assaulted with a hammer and sustains a depressed
a or che skull Profuse venous bleeding is noted at the fracture site. Which
vascular structure is most likely to have been perforated?

A. Cavernous sinus

B. Inferior sagittal sinus
€. Sigmoid sinus

D. Superior petrosal sinu

111. 4. A 30-year-old man is assaulted with a hammer and sustains a depressed
aa. the skull Profuse venous bleeding is noted at the fracture site. Which
vascular structure is most likely to have been perforated?

ACavemoussians remember there is another important land mark in the skull called

B. Inferior sagittal sinus
C. Sigmoid sinus

The Pterion it is the site for Middle menengeal artery mostly got

injuried
D. Superior petrosal sinus because it's the weakest point in the skull

112. 142. A 19- year-old man fell down a flight of stairs. On presentation to the Emergency
ith no local neurological signs. An

Department his Glasgow Coma Score
ur later he Vomited and his He developed a fixed and dilated

Which of the following is likely to seen on the scan?

A. Left-sided acute subdural haematoma

C. Left-sided midbrain haematoma
D. Right-sided acute subdural haematoma
E. Right-sided extradural haematoma

113. 144. A 70-year-old woman from a nursing home is brought to' the Emergency Department
with abdominal pain and vomiting. On examination, she is dehydrated and her abdomen is
distended. There is a 3 cm x 4 cm swelling in the right groin which is nontender, and there
is no cough impulse. At operation, a femoral hernia is found. Which one of the following
lies immediatel
A. Femoral artery
emoral nerve

D. Inguinal ligament
E. Pectineal ligament

114. 145. A 64-year-old woman is-reviewed in the Emergency Department with an acute
right groin swelling, below and lateral to the pubic tubercle. Which of the following forms
the AE hough which this hernia is protruding?

A. Conjoint tendon
B. Inferior epigastric artery
C. Inguinal ligament

E. Pectineal ligament

115. 149. A 58-year-old man, admitted for inguinal hernia surgery, is found to have an enlarged
heart shadow on his chest radiograph. Which one of the/following statements is true of the

A. Has a muscular wall that is normally thicker than that of the Left ventricle
B. Forms the apex of the heart
C. Forms the right border of the heart

E. Gives rise to the aorta

116. 150. A 67-year-oid man is admitted to hospital for investigation of at irregular heart beat.
The of the heart includes which one of the following anatomical

B. Chordae tendineae
C. Fibrous skeleton of the heart

D. Interatrial septum
E. Phrenic nerve

117. 153. A 24-year-old man is assaulted and sustains a deep 2 cm long laceration to the lateral

aspect of his lower leg. Physical examination show's that the laceration is
is Which of the following structures is most at risk of

being divided?

A. Peroneus brevis
B. Peroneus longus
C. Saphenous nerve

D cial p
E. Sural nerve

118. 160. A.58 year-old man is due to have surgery for Dupuytrens contracture to release

the ring finger of the light hand. 'Which one of the following regarding the anatomy

B. Has no cutaneous innervation from the median nerve

€. Has no cutaneous innervation from the ulnar nerve

D. Has the flexor digitorum profundus inserting into the middle phalanx
E. Is abducted by a palmar interosseous muscle

yes rai nerve innervation of the hand is masked by the ulnar and median nerve

119. 161. A 75-year-old man presents with deep vein thrombosis. Computerized Tomography
confirms the presence of a thrombus' in His common iliac vein extending into the
inferior vena cava The common iliac veins join to form th
which vertebral level?

A.L3
B.L4
CLS
D.Sı
E52

120. 162. A 35-year-old motorcyclist is involved in a road traffic accident and fractures his

temporal bone, completel
‘ganglion. Which function of this nerve remains?

B. Salivation from the submandibular gland
€. Sensation to the anterior tongue

D. Smile

E. Taste

121. 165. A4- -year-old boy presents to the Aria Department with a two-day lia] of

B. Infundibular recess

C. Interventricular foramen (of Monro)

D. Lateral foramen of fourth ventricle (foramen of Luschka)
E. Median foramen of fourth ventricle (foramen of Magedie)

122. 167. During arch aortography, the
which of the following?

A. Arch of the aorta

B. Brachiocephalic artery
€. Common carotid artery
D. Internal carotid-artery

123. 169. A 12-year-old child was admitted to the Emergency Department having inhaled a
peanut. Where will the peanut most likely to have lodged?

A. Left lower lobe bronchus
B. left upper lobe bronchus

D. Right middle lobe bronchus
E. Right upper lobe bronchus

124. 172. A-56 year old man presents with headache and vomiting with deterioration over the
last two weeks. On examination he has papi! ma. A CT scan shows a space occupying
lesion in the right parietal lobe. He develops a st . Which
past of the visual system to be affected?

A. Lens
B. Optic Chiasm

D. Retina
E. Second cranial nerve

125. 174.A 65 years old man with known ischemic heart disease and atrial fibrillation presents
mb. Which arterial territory is most likely to be

involved?

B. Left middle cerebral

C. right anterior cerebral
D. Right middle cerebral
E. Right posterior cerebral

126. 176. A 56-year-old man with chronic emphysema is on the high dependency unit (HDU),
ten days after anterior resection. He has developed acute shortness of breath' and
hypotension): Which of the following I narks would be the most appropriate to use to

€. A point midway between the greater trochanter and the pubic symphysis

D. a point 1 cm inferior and 4 cm lateral to the pubic tubercle

E. A point 2 cm lateral to the midway point between the anterior superior iliac spine and
pubic symphysis