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59 Cards in this Set
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(Q62 Aug 2008) The ascending aorta
A has no branches B begins at the semilunar valve C arises from right ventricle D occupies the superior mediastinum E lies inferior to the SVC |
B begins at the semilunar valve
- A has no branches - false - coronary arteries branch from the ascending aorta B begins at the semilunar valve - true - aortic and pulmonary valves are semilunar valves. C arises from right ventricle - definitely false D occupies the superior mediastinum - much debated on the wiki about this. Aortic ARCH occupies superior mediastinum. Ascending aorta is in the MIDDLE mediastinum (inferior is divided into anterior, middle and posterior) E lies inferior to SVC - false! ----------- |
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(Q85 Aug 2008) The left recurrent laryngeal nerve
A hooks around the arch of the aorta anterior to the attachment of the ligamentum arteriosum B passes under cover of the lower border of the inerior constrictor muscle before entering the larynx C supplies the cricothyroid muscle D supplies sensation to the whole of the laryngeal mucosa on the left side E contains motor fibres derived from the spinal root of the accessory nerve |
B passes under cover of the lower border of the inerior constrictor muscle before entering the larynx
- A hooks around the arch of the aorta anterior to the attachment of the ligamentum arteriosum - false - POSTERIOR B passes under cover of the lower border of the inferior constrictor muscle before entering the larynx - true - the RLN enters the pharynx by passing upwards under the lower border of the inferior constrictor behind the cricothyroid joint. Ref: Last's Anatomy. C supplies the cricothyroid muscle - false - external branch of the superior laryngeal supplies this D supplies sensation to the whole of the laryngeal mucosa on the left side - false - internal branch of the SLN supplies laryngeal mucosa ABOVE cords, RLN supplies BELOW cords E contains motor fibres derived from the spinal root of the accessory nerve - false. Vagus. ----------- |
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(Q102 Aug 2008)
The nerve providing sensory supply to the airway muscle below (inferior) to the vocal cords is the A. phrenic nerve B. posterior thyroid nerve C. recurrent laryngeal nerve D. superior laryngeal nerve E. tracheal nerve |
C. recurrent laryngeal nerve
provides sensation to the glottis, sub glottis and trachea -- A. False - phrenic nerve supplies diaphragm B. not sure if posterior thyroid nerve even exists!!! D. False - superior laryngeal nerve supplies sensation SUPERIOR to the vocal cords It divides into the internal and external branches: - internal branch: general sensation pain, touch, temp for tissue superior to vocal cords accompany the visceral sensory axons and run in the internal branch of the SLN. It exits the larynx and pharynx through a foramen in postinf portion of thyrohyoid membrane. The nerve provides sensation of the base of tong, both surfaces of epiglottis, aryepiglottic foods and the vestibule of the larynx to level of vocal cords. Then unites with external branch to ascend in neck to join rest of vagus before it reaches inf vagal ganglion. - external branch: branchial MOTOR axons in the EXTERNAL branch of the SLN supply the inferior constrictor muscles and the cricothyroid muscles. External branch also contributes to pharyngeal plexus (supplying palate and pharynx along with branches from external laryngeal and pharyngeal nerves and branches from CNIX and sympathetic trunk). E. see B!! ----------- |
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[Aug08-138][Aug12] Ciliary ganglion
A sympathetic from inferior cervical ganglion B located inferiorly within orbit C may be damaged during a peribulbar block D preganglionic parasympathetic supply from the supra trochlear nerve E preganglionic parasympathetic originates from the Edinger Westpal nucleus |
E preganglionic parasympathetic originates from the Edinger Westpal nucleus
- Ciliary ganglion - parasymp root - from Edinger Westphal part of oculomotor nucleus by a branch from the herve to the inferior oblique muscle from the inferior division of the oculomotor n. - symp root - from superior cervical ganglion by branches of the internal carotid nerve - sensory root - from a branch of the nasociliary nerve, with cell bodies in the trigeminal ganglion - branches - short ciliary nerves to the eye ----------- |
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[Mar10][Aug12] You are performing a bronchoscopy, but are unsure of your location. Then you see trifurcation of bronchi. Most likely location is:
A. Right upper lobe B. RML C. RLL D. LUL E. Lingula <br |
A. Right upper lobe
- see wiki Mar10 exam ----------- |
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NA04 [Aug93] [Aug94] [Jul04]
The pudendal nerve: A. Crosses the greater sciatic foramen B. Crosses the lesser sciatic foramen C. Gives off the inferior haemorrhoidal nerve D. Gives the posterior cutaneous nerve of the thigh E. Arises from S2-S4 |
E. Arises from S2-S4
~~ Pudendal nerve responsible for orgasm, urination, defaecation Pudendal nerve arises from S2,3,4 ➭ leaves pelvis through greater sciatic foramen ➭ loops behind ischial spine ➭ re-enters through lesser sciatic foramen ➭ passes through pudendal (Alcock's) canal ➭ gives of inferior rectal nerves ➭ 2 terminal branches - perineal nearve - dorsal nerve of clitoris/penis ----------- The pudendal nerve originates in the sacral plexus; it derives its fibers from the ventral branches of the second, third, and fourth sacral nerves (S2, S3, S4). It passes between the piriformis and coccygeus muscles and leaves the pelvis through the lower part of the greater sciatic foramen. It crosses the spine of the ischium, and reenters the pelvis through the lesser sciatic foramen. It accompanies the internal pudendal vessels upward and forward along the lateral wall of the ischiorectal fossa, being contained in a sheath of the obturator fascia termed the pudendal canal. The pudendal nerve gives off the inferior rectal nerves. It soon divides into two terminal branches: the perineal nerve, and the dorsal nerve of the penis (males) or the dorsal nerve of the clitoris (in females). |
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NA06
The ilioinguinal nerve: A. Supplies the rectus abdominus muscle B. Does NOT give off a lateral cutaneous branch C. Supplies the cremaster muscle D. Supplies the urethra E. Does NONE of the above |
B. Does NOT give off a lateral cutaneous branch
- intercostal n T7-T11, subcostal(T12) iliohypogastric (L1) all give off lat cut. br in mid axillary line but not ilioinguinal n. Supplies skin of scrotum/labium majus + upper thigh. Consider the ilioinguinal as an accessory iliohypogastric. It has no lateral branch as the intercostals/subcostal/iliohypog. Stroking the medial upper thigh in the ilioinguinal cutaneous distribution causes reflex contraction of cremaster via genital branch of genitofemoral nerve (L1,2) ----------- |
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NA11b ANZCA version [2004-Apr] Q41
The segmental nerve supply to the renal pelvis and the ureter gives an anatomical basis for the surface representation of the pain of renal colic. The segments concerned are A. T11 and T12 B. L1 C. L1 and L2 D. T11, T12, L1 and L2 E. T12 and L1 |
D. T11, T12, L1 and L2
Innervation of renal pelvis is from the renal plexus which has a complex supply from the abdomino pelvic splanchnic nerves originating from segments T11, T12, L1, L2. Note: in renal colic, pain is referred into scrotum (ie. genitofemoral distribution - L1,2) ----------- |
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NA15 ANZCA version [Mar92] [Aug92] [Mar93] [Aug93] [2002-Mar] Q18, [2002-Aug] [Mar10] [Aug10] [Aug12]
The skin of the anterolateral part of the gluteal region, between the iliac crest and the greater trochanter, is supplied by the A. Ilioinguinal nerve B. Genitofemoral nerve C. Superior gluteal nerve D. Subcostal nerve E. Lateral cutaneous nerve of the thigh F. Femoral nerve |
D. Subcostal nerve
Subcostal nerve = T12 intercostal = MUFFIN TOPS (see picture below) Each nerve from T7 to T12 also gives off a lateral cutaneous branch (with anterior and posterior branches), which divides in the mid-axillary line. These branches supply the skin of the flank and back in the relevant distribution. The iliohypogastric and subcostal nerves, however, do not have a divided lateral cutaneous nerve, but continue down to supply the skin over the upper lateral buttock. The ilioinguinal nerve has no lateral cutaneous branch. Concise Anatomy for Anaesthesia "supplies sensory innervation to the skin over the hip." Wikipedia - A. ilioinguinal nerve - false B. genito-femoral nerve - false C. superior gluteal nerve - false: "The superior gluteal nerve (L4, 5, S1) accompanies the superior gluteal vessels as the only structures that pass through the upper compartment of the greater sciatic foramen (above piriformis). It supplies gluteus medius and minimus and tensor fasciae lata." (Ellis) D. subcostal nerve - true: "The 12th thoracic (subcostal) nerve runs along the lower border of the 12th rib below the subcostal vessels, passes behind the lateral arcuate ligament to run in front of quadratus lumborum behind the kidney and colon. The nerve then passes between transversus abdominis and internal oblique and then has a course and distribution which are similar to the lower intercostal nerves. However, there is one point of difference: the lateral cutaneous branch of the 12th nerve descends without branching to supply the skin over the lateral aspect of the buttock" (Ellis) E. lateral cutaneous nerve of thigh - false: "The anterior branch supplies the skin over the antero-lateral aspect of the thigh down to the knee, where it links up with twigs from the intermediate cutaneous nerve of the thigh and the infrapatellar branch of the saphenous nerve to form the patellar plexus. The posterior branch penetrates the fascia lata to innervate the skin of the lateral aspect of the leg from the greater trochanter to the mid-thigh." ----------- |
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NA16 ANZCA version [2004-Apr] Q6, [2004-Aug] Q34
The pudendal nerve does NOT A. give off the inferior haemorrhoidal nerve B. cross the greater sciatic foramen C. cross the lesser sciatic foramen D. arise from L2-3-4 E. give off the dorsal nerve of the penis |
D. arise from L2-3-4
arises from S2,3,4 !! ~~ Pudendal nerve responsible for orgasm, urination, defaecation Pudendal nerve arises from S2,3,4 ➭ leaves pelvis through greater sciatic foramen ➭ loops behind ischial spine ➭ re-enters through lesser sciatic foramen ➭ passes through pudendal (Alcock's) canal ➭ gives of inferior rectal nerves ➭ 2 terminal branches - perineal nearve - dorsal nerve of clitoris/penis ----------- The pudendal nerve originates in the sacral plexus; it derives its fibers from the ventral branches of the second, third, and fourth sacral nerves (S2, S3, S4). It passes between the piriformis and coccygeus muscles and leaves the pelvis through the lower part of the greater sciatic foramen. It crosses the spine of the ischium, and reenters the pelvis through the lesser sciatic foramen. It accompanies the internal pudendal vessels upward and forward along the lateral wall of the ischiorectal fossa, being contained in a sheath of the obturator fascia termed the pudendal canal. The pudendal nerve gives off the inferior rectal nerves. It soon divides into two terminal branches: the perineal nerve, and the dorsal nerve of the penis (males) or the dorsal nerve of the clitoris (in females). |
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NH01 ANZCA version [2001-Aug] Q103, [2002-Mar] Q113
The trigeminal nerve 1. is attached to the pons 2. is sensory to the face 3. is motor to the muscles of mastication 4. is joined to the trigeminal (semilunar) ganglion by a motor root and by a sensory root |
1. is attached to the pons
2. is sensory to the face 3. is motor to the muscles of mastication Trigeminal Nerve (CN V): ➭ orininates from trigeminal nucleus (extends from midbrain to medulla) and emerges from level of the pons with a thick sensory root and a small motor root ➭ 3 divisions: ophthalmic, maxillary, and mandibular (exit skull through superior orbital fissure, foramen rotundum, and foramen ovale - SRO) ➭ Sensory to face, nose, mouth and orbit ➭ Motor to muscles of mastication 4. is joined to the trigeminal (semilunar) ganglion by a motor root and by a sensory root false. The V1 and V2 are entirely sensory. V3 has a motor component which runs inferiorly to the ganglion (ie. has no connection with it) and joins the sensory V3 outside of the cranium. Reference Gray's. ----------- |
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NH11
The principal nerve supply of the hard palate is: A. Sphenopalatine nerve B. Lesser palatine nerve C. Infraorbital nerve D. Greater palatine nerve |
D. Greater palatine nerve (and nasopalatine)
see NH32 related Q. -- Sphenopalatine / Nasopalatine: septum/lateral/inferior nose passes through incisive foramen to hard palate sensation back to canines. Greater palatine does behind that. Lesser palatine nerves do soft palate/uvula/tonsil. D - Branch of maxillary n. (CN V2), via pterygopalatine ganglion. ----------- |
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NH14 ANZCA version [1985] [Mar93] [Mar94] [Aug96] [Apr99] [2004-Aug] Q24, [2005-Apr] Q48, [Jul06] [Apr07] [Jul07]
Sensation from the lobule of the external ear is mediated mostly by: A. The auriculotemporal nerve B. The great auricular nerve C. The lesser occipital nerve D. The greater occipital nerve E. None of the above |
B. The great auricular nerve
~~ - greater auricular (cervical plexus): a "great" place to put an earing. - lesser occipital (cervical plexus): "less" people wear earings there. - auricilar branch of vagus: behind the tragus - auriculotemporal (mandibular): near the temple Four nerve branches supply the sensory innervation of the ear. The anterior half of the ear is supplied by the auriculotemporal nerve, which is a branch of the mandibular portion of the trigeminal nerve. The posterior half of the ear is innervated by 2 nerve branches derived from the cervical plexus: the great auricular nerve and the lesser occipital nerve. The auditory branch of the vagus nerve innervates the concha and external auditory canal http://www.emedicine.com/derm/topic824.htm ----------- The auricular branch of the vagus supplies the medial aspect of the auricle, the external auditory meatus, and the outer surface of the tympanic membrane. It communicates with the facial nerve both in the petrous temporal bone and again with the posterior auricular branch of VII on emerging from the bone. This is Alderman’s nerve, cold water or other stimuli applied to the external ear are said to stimulate the appetite vagal innervation of both the external ear and the gastric secretory and emptying mechanism |
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NH20b [Aug91] [Jul06] [Apr07] Q7
The most direct branch of the internal carotid artery: A. Ophthalmic artery B. Choroidal artery C. Anterior cerebral artery D. Middle cerebral artery E. Posterior cerebral artery |
D. Middle cerebral artery
✔ ----------- |
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NH22 ANZCA version [1988] [Mar92] [Aug92] [2004-Apr] Q12, [2004-Aug] [Oct08][Oct09][Mar10]
Branches of the mandibular nerve do NOT include the A. auriculotemporal nerve B. long buccal nerve C. lingual nerve D. great auricular nerve E. chorda tympani nerve |
D. great auricular nerve
Greater auricular nerve is derived from cervical plexus Mandibular nerve exits through the foramen ovale and gives off two branches (sensory to the dura mater, motor to the medial pterygoid muscle), before bifurcating into the anterior (small) and posterior (large) trunks: ➭ Anterior trunk – gives off: - Buccal nerve - Masseteric nerve - Deep temporal nerves - Nerve to lateral pterygoid ➭ Posterior trunk – gives off: - Auriculotemporal nerve - Lingual nerve - Inferior alveolar nerve - From WIKI: Distribution of the mandibular nerve from Ellis pp261-262 The mandibular nerve soon divides into a smaller anterior and larger posterior trunk; the branches of the nerve and its trunk may be summarized thus: 1 Undivided trunk: (a) nervus spinosus (sensory); (b) nerve to medial pterygoid (motor). 2 Anterior trunk: (a) buccal nerve (sensory); - in answer (b) masseteric nerve (motor); (c) deep temporal nerves (motor); (d) nerve to lateral pterygoid (motor). 3 Posterior trunk: (a) auriculotemporal nerve (sensory); - in answer (b) lingual nerve (sensory); - in answer (c) inferior alveolar nerve (mixed). [edit] The Chorda tympani from Ellis p269 Just before entering this foramen, the facial nerve gives off the chorda tympani, which pierces the posterior wall of the tympanic cavity close to the deep surface of the ear drum. It runs forward over the pars flaccida of the tympanic membrane and the neck of the malleus, lying immediately beneath the mucous membrane throughout its course. It passes out through the front of the middle ear by piercing the bone at a canaliculus at the inner end of the petrotympanic fissure. It emerges from this fissure to join the lingual nerve about 2.5 cm below the base of the skull. Through the chorda tympani, taste fibres are conveyed from the anterior two-thirds of the tongue and secretomotor fibres reach the submandibular ganglion. [edit] The great auricular nerve from Ellis p148 The great auricular nerve (C2, 3) is the largest cutaneous branch of the cervical plexus. It hooks around the mid-point of the posterior border of sternocleidomastoid, then passes across it in the direction of the angle of the mandible. On this muscle it breaks up into three terminal branches. 1 Auricular - supplying the lower two-thirds of the medial aspect of the external ear and the lateral surface of the lobule. 2 Mastoid - to the skin over the mastoid process. 3 Facial - to the skin over the masseter and the parotid gland. ----------- |
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NH26 [Aug96] [Jul97] [Mar00]
Branch of anterior division of mandibular nerve: A. Innervates cheek B. Goes through pterygopalatine fossa C. Innervates teeth of lower jaw D. Carries chorda tympani E. Innervates tongue |
A. Innervates cheek
➭ Anterior trunk of mandibular nerve gives off: - Buccal nerve (sensory to cheek) - Masseteric nerve (motor to masseter) - Deep temporal nerves (motor to temporalis) - Nerve to lateral pterygoid ----------- |
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NH27 ANZCA version [Apr97] [Jul98] [2002-Apr] Q107, [2002-Aug] Q141
Nerves which supply the ear include the 1. mandibular nerve 2. vagus nerve 3. facial nerve 4. maxillary nerve |
1. mandibular nerve
2. vagus nerve 3. facial nerve - mandibular nerve – via auriculotemporal nerve: near the temple - vagus nerve – via auricular branch: behind the tragus - facial nerve *via posterior auricular nerve, which gives auricular branches to the extrinsic muscles of the ear *nerve to stapedius branches off facial nerve before the chorda tympani. Also posterior auricular nerve supplies the extrinsic muscles of the ear. Facial nerve supples "general sensation from a small area around the external acoustic meatus....." + post auricular nerve (motor to extrinsic ms of ear) Moore p. 664 (3rd ed). ----------- |
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NH28 ANZCA version [Aug99] [Mar00] [Jul00] [2001-Aug] Q14, [2002-Aug] Q12
The cutaneous nerve supplying the territory marked 'A' in the figure below is A. the greater occipital nerve (a branch of the posterior primary ramus of C 1) B. the greater occipital nerve (a branch of the posterior primary ramus of C 2) C. the lesser occipital nerve (a branch of the posterior primary ramus of C 2) D. the lesser occipital nerve (a branch of the anterior primary ramus of C 2) E. the third occipital nerve |
B. the greater occipital nerve (a branch of the posterior primary ramus of C 2)
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NH29 ANZCA version [2001-Apr] Q83, [2003-Apr] Q94, [2003-Aug] Q80
Sensory nerves supplying the territory marked "B" in the figure below, are derived from the nasal branch of the A. anterior ethmoidal nerve B. infra-trochlear nerve C. infra-orbital nerve D. lacrimal nerve E. nasopalatine nerve |
B. infra-trochlear nerve
~~ The infratrochlear nerve is given off from the nasociliary just before it enters the anterior ethmoidal foramen. It runs forward along the upper border of the medial rectus, and is joined, near the pulley of the superior oblique, by a filament from the supratrochlear nerve. It then passes to the medial angle of the eye, and supplies the skin of the eyelids and side of the nose, the conjunctiva, lacrimal sac, and caruncle. ----------- A. anterior ethmoidal nerve – branch of the nasociliary nerve, supplying the inner and outer aspects of the tip of the nose via the external nasal nerve. B. infra-trochlear nerve – branch of the nasociliary, innervates the side of the nose and the conjunctiva. Picture quite clearly points to the side of the nose, not the tip and not the bridge – but does the infratrochlear branch of the nasociliary actually have a nasal branch?? C. infra-orbital nerve – supplies maxilla below the eye and side of nose, as well as upper lip and teeth. Acually has a nasal branch, also a palprebral and labial branch. Why is this not the answer, then? D. lacrimal nerve – branch side of the ophthalmic division, along with frontal and nasociliary E. nasopalatine nerve Tip of the nose – anterior ethmoidal Side of the nostrils – infraorbital Bridge of the nose - infratrochlear OPHTHALMIC DIVISION Entirely sensory Supplies eyes, nose skin of the forehead and scalp to the vertex Branches: • Lacrimal • Frontal • Nasociliary LACRIMAL NERVE Smallest of the three Passes through superior orbital fissure, supplies the lacrimal gland, communicates with the zygomatic branch of the maxillary. FRONTAL NERVE Largest branch Passes the superior orbital fissure above the orbital ring and above levator palpebrae superioris. Within the orbit it divides into the supraorbital and supratrochlear nerves. NASOCILIARY Many branches including: • Long ciliary (2) • Short ciliaries (via the ciliary ganglion) • Infratrochlear • Anterior ethmoidal – becomes the external nasal • Posterior ethmoidal |
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NH30 ANZCA version [2005-Apr] Q140, [Jul05] [Mar06] [Sep11] [Mar12]
The muscles of the upper eyelid receive a somatic nerve supply from the A. oculomotor nerve and a parasympathetic supply from the superior vagus nerve B. oculomotor nerve and a sympathetic supply from the superior cervical ganglion C. ophthalmic division of the trigeminal nerve and a parasympathetic supply from the superior vagus nerve D. ophthalmic division of the trigeminal nerve and a sympathetic supply from the superior cervical ganglion E. ophthalmic division of the facial nerve only |
B. oculomotor nerve and a sympathetic supply from the superior cervical ganglion
- oculomotor nerve = CN III - levator palpebrae superioris is supplied by the superior division of the oculomotor nerve - in Horner's Syndrome (damage to the sympathetic nervous system) you get ptosis note: in diagram 9 = levator palpebrae superioris, 10 = Superior tarsus - ophthalmic division of trigeminal is sensory only ----------- |
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NH31 ANZCA version [Apr08] Q131
You are performing an awake fibreoptic intubation, through the nose, on an adult patient. In order, the fibrescope will encounter structures with sensory innervation from the following nerves: A. facial, trigeminal, glossopharyngeal B. facial, trigeminal, vagus C. glossopharyngeal, trigeminal, vagus D. trigeminal, glossopharyngeal, vagus E. trigeminal, vagus, glossopharyngeal |
D. trigeminal, glossopharyngeal, vagus
- * Three major neural pathways supply sensation to airway structures (see Figure 1). * Terminal branches of the ophthalmic and maxillary divisions of the trigeminal nerve supply the nasal cavity and turbinates. * The oropharynx and posterior third of the tongue are supplied by the glossopharyngeal nerve. * Branches of the vagus nerve innervate the epiglottis and more distal airway structures. ➚ Internal Branch ● SENSORY above cords Superior + inferior epiglotis ➚ Laryngeal N. ➘ External Branch ● MOTOR to cricothyroid 'eee' VAGUS ➘ Recurrent Laryngeal N. ● ALL intrinsic muscles EXCEPT cricothyroid ----------- |
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NH32 [Mar12]
Which nerves need to blocked to anaesthetise the hard palate: A. Superior labial nerve and greater palatine nerve B. Greater palatine nerve and nasopalatine nerve C. Inferior orbital nerve and nasopalatine nerve D. Glossopharyngeal nerve and… E. Anterior ethmoidal nerve and… |
B. Greater palatine and nasopalatine
The hard palate consists of the palatine process of the maxillary bone and the horizontal plate of the palatine bone. The incisive canal is in the anterior midline and transmits the following branches: - NASOPALATINE AND GREATER PALATINE NERVES. Branches of the maxillary nerve (CNV2); provides general sensation to the palate - Sphenopalatine and greater palatine arteries. Branches of the maxillary artery originating from the infra temporal fossa. ----------- |
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NL04 ANZCA version [2004-Aug] Q41, [2005-Apr] Q62 (Similar version reported in [1986] [Mar94] [Mar06] [Jul06][Apr08][Oct08][Aug10]
The sciatic nerve supplies the following muscles EXCEPT A. biceps femoris B. semitendinosus C. semimembranosus D. gluteus maximus E. adductor magnus |
D. gluteus maximus
Inferior gluteal nerve supplies gluteus maximus (L5, S1, S2) -- Sciatic nerve - formed from L4,5 and S1-3 - terminates in the common peroneal and tibial nerves above the knee - Supplies ● Muscular branches to – semitendinosus, semimembranosus, adductor magnus (half) and biceps femoris ● Nerve to quadratus femoris – also inferior gemellus and sensory to the hip joint ● Nerve to obturator internus – also superior gemellus -- Note - muscular br of sciatic n is BASS: Biceps femoris Adductor magnus Semimembranosus Semitendonosus ----------- |
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NL06 ANZCA version [1988] [2004-Apr] Q47
The fourth lumbar nerve A. is distributed to the skin on the medial aspect of the lower leg B. is distributed to the flexors of the hip C. supplies the skin over the buttock via its dorsal ramus D. contributes to the obturator nerve via the dorsal division of its ventral ramus E. has none of the above properties |
A. is distributed to the skin on the medial aspect of the lower leg
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NL07 ANZCA version [Aug91] [2002-Aug] Q19
The sciatic nerve is located midway between the greater trochanter and the A. iliac crest B. ischial tuberosity C. ischial ramus D. symphysis pubis E. tip of the coccyx |
B. ischial tuberosity
- "The sciatic nerve leaves the posterior pelvic wall through the greater sciatic foramen below piriformis and enters the region of the buttock very slightly medial to the half-way point between the ischial tuberosity and the greater trochanter." (Ellis p198) ----------- |
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NL08 [Aug91] [Mar06]
The sural nerve A. is a branch of the posterior tibia1 nerve B. supplies the skin of the anterior two thirds of the sole of the foot C. lies anterior to the lateral malleolus at the ankle D. reaches the foot in contact with the short saphenous vein E. supplies the small muscles of the foot |
D. reaches the foot in contact with the short saphenous vein
Sural nerve: This supplies sensation to the fifth toe and the lateral border of the foot. It is a branch of the tibial nerve. At the level of the ankle it lies superficially behind the lateral malleolus. ----------- |
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NL12b ANZCA version [2003-Apr] Q91, [2005-Apr] Q58, [Jul05]
The sciatic nerve A. can be readily identified during neural blockade by the production of paraesthesia on contact with a needle B. has no sympathetic fibres C. is formed from the dorsal branches of the anterior rami of L5 and S1 to S4 D. provides motor innervation to the psoas muscle E. provides sensory innervation to the knee joint |
E. provides sensory innervation to the knee joint
- Provides motor above the knee and sensory below the knee "Every spinal nerve without exception carries post-ganglionic (grey ramus) sympathetic fibres, to vessels, sweat glands and hair roots" Sciatic nerve - formed from L4,5 and S1-3 - terminates in the common peroneal and tibial nerves above the knee - Supplies ● Muscular branches to – semitendinosus, semimembranosus, adductor magnus (half) and biceps femoris ● Nerve to quadratus femoris – also inferior gemellus and sensory to the hip joint ● Nerve to obturator internus – also superior gemellus ----------- |
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NL14 [Jul00]
Common peroneal nerve: A. Supplies biceps femoris B. Forms lateral plantar nerve C. ?Passes between tibia & fibula D. Supplies dorsiflexors of foot |
D. Supplies dorsiflexors of foot
Common peroneal nerve – derived from the sciatic nerve in the lower third of the thigh. It runs in the lateral part of the popliteal fossa before winding around the neck of the fibula. It then divides (deep to peroneus longus) into two branches – supericial peroneal and deep peroneal nerves. Trauma to the nerve can result in a condition called foot drop, where dorsiflexion of the foot is compromised and the foot drags during walking, and sensory loss to the dorsal surface of the foot and portions of the anterior, lower-lateral leg. ----------- |
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NL15 ANZCA version [2003-Apr] Q16, [2003-Aug] Q38, [Jul05]
The second lumbar nerve root (L2) normally contributes to the each of the following nerves EXCEPT A. femoral nerve B. obturator nerve C. genito-femoral nerve D. lateral cutaneous nerve of the thigh E. ilio-inguinal nerve |
E. ilio-inguinal nerve
- also does not supply iliohypogastric From the lumbar plexus, Ellis p.183 Summary of branches of the lumbar plexus Iliohypogastric L1 Ilio-inguinal L1 Genitofemoral L1, 2 Dorsal divisions lateral cutaneous nerve of thigh L2, 3 femoral nerve L2–4 Ventral divisions obturator nerve L2–4 accessory obturator nerve L3, 4 ----------- |
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NN05 ANZCA version [2004-Aug] Q17, [2005-Apr] Q63, [Apr07] [Sep11][?Aug12]
The carotid sinus derives its nerve supply from the A. vagus nerve B. glossopharyngeal nerve C. ansa cervicalis (hypoglossi) D. middle cervical ganglion E. stellate ganglion |
B. glossopharyngeal nerve
● Carotid nerve (branch of glossopharyngeal) – runs down the internal carotid artery and supplies the carotid sinus (pressor) and body (chemo) Vagus nerve is efferent. ----------- |
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NN13 [1986] [2004-Aug] Q29, [2005-Apr] Q75, [Apr07] [Jul07] [Oct09][Mar10] [Aug10]
The innervation of the human larynx is such that A. the internal laryngeal branch of the superior laryngeal branch of the vagus supplies the lingual surface of the epiglottis B. in the cadaveric position the cords are fully abducted C. the recurrent laryngeal nerve supplies all the intrinsic muscles of the larynx D. the glossopharyngeal nerves are sensory to the laryngeal mucous membrane above the level of the vocal cords E. cord paralysis can be produced by a distended endotracheal cuff in the larynx compressing a branch of the recurrent laryngeal nerve against the thyroid cartilage |
E. cord paralysis can be produced by a distended endotracheal cuff in the larynx compressing a branch of the recurrent laryngeal nerve against the thyroid cartilage
- A. is incorrect - the GLOSSOPHARYNGEAL supplies the lingual surface of the epiglottis. THE SLN supplies POSTERIOR epiglottis and the interior larynx as far as the vocal cords. B. false - in the cadaveric position the cords are partially abducted with minimal airflow compromise C. false – the VAGUS NERVE supplies all the intrinsic muscles, via the SUPERIOR LARYNGEAL NERVE (external branch supplies cricothyroid) and the recurrent laryngeal (which is also a branch of the vagus) supplies the rest D. false. Above the vocal cords sensation is supplied by the internal laryngeal nerve (internal branch of SLN which is a branch of VAGUS). E = true. - Compression by a cuff of the recurrent laryngeal nerve against the thyroid cartilage causes paralysis on that side T– see St George notes (last question) indicating that the anterior branch of the recurrent laryngeal nerve is damaged by being compressed by the cuff below the cords and pushed against the thyroid cartilage. ----------- |
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NN14 ANZCA version [Mar93] [Aug93] [Aug96] [Jul98] [Apr99] [2004-Aug] Q28, [2005-Apr] Q34, [Jul05] [Jul07] [?Aug12]
The muscles of the larynx which separate the vocal cords are the A. thyro-arytenoids B. lateral crico-arytenoids C. oblique arytenoids D. posterior crico-arytenoids |
D. posterior crico-arytenoids
- "The posterior cricoarytenoid muscle arises from the posterior surface of the lamina of the cricoid and is inserted into the posterior aspect of the muscular process of the arytenoid. It abducts the cord by external rotation of the arytenoid and thus opens the glottis; it is the only muscle to do so." (Ellis, Anatomy for Anaesthetists, 8ED, p34) ● Posterior crico-arytenoid – opens the glottis by the abducting cords ● Lateral crico-arytenoid – closes the glottis by the adducting cords Concise Anatomy for Anaesthesia ----------- |
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NN23 ANZCA version [Aug92] [Mar93] [Aug93] [Apr96] [Aug99] [Mar00] [Jul00] [2002-Aug] Q39, [2003-Apr] Q55
The neural structure LEAST likely to be injured during attempted cannulation of the internal jugular vein at the level of the cricoids cartilage, using an anterior approach, is the A. ansa cervicalis B. cervical plexus C. phrenic nerve D. recurrent laryngeal nerve E. vagus nerve |
D. recurrent laryngeal nerve
(Previous grp answer) The brachial plexus, stellate ganglion, vagus, accessory, hypoglossal and phrenic nerves are all closely associated with the internal jugular vein. Any of these structures may be injured during cannulation attempts. The ansa cervicalis (or ansa hypoglossi in older literature) is a loop of nerves that are part of the cervical plexus. ----------- |
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NN26 ANZCA version [Mar94] [Aug94] [2004-Apr] Q44
A lesion of the right recurrent laryngeal nerve A. results in an inability to tense the right vocal cord B. results in a complete failure of adduction of the right vocal cord C. results in a complete failure of abduction of the right vocal cord D. may occur during surgical exposure of the superior thyroid vessels E. always results in hoarseness |
C. results in a complete failure of abduction of the right vocal cord
- Prev grp said B. A. results in an inability to tense the right vocal cord - false: cricothyroid remains intact and acts as a tensor of the cord. It is supplied by external largyngeal nerve (a branch of the superior laryngeal nerve). "Contraction of this muscle elevates the anterior part of the arch of the cricoid, approximating it to the thyroid cartilage. The effect of this is to tilt the lamina of the cricoid, bearing with it the arytenoid, posteriorly, thus lengthening the anteroposterior diameter of the glottis and thus, in turn, putting the vocal cords on stretch (Fig. 28). This muscle is the only tensor of the cord." (Ellis) B. results in a complete failure of adduction of the right vocal cord - true but only with complete transection: "The recurrent laryngeal nerve provides innervation to all the other intrinsic muscles of the larynx, including the only abductor of the vocal cords, the posterior cricoarytenoid. The recurrent laryngeal nerve supplies abductor fibers (posterior cricoarytenoid) and adductor fibers to the other intrinsic laryngeal muscles. The abductor fibers within the recurrent laryngeal nerve are more sensitive and vulnerable to trauma than the adductor fibers. A partial injury to the recurrent laryngeal nerve can produce a pure abductor paralysis, whereas complete transection of the recurrent laryngeal nerve produces an abductor and adductor fiber injury.[3] This variable sensitivity of the recurrent laryngeal nerve to either abductor injury or abductor and adductor injury accounts for the different clinical presentations of patients with nerve damage." (Miller Ch 75) C. results in a complete failure of abduction of the right vocal cord - true: See above D. may occur during surgical exposure of the superior thyroid vessels - false: More likely INFERIOR THYROID ARTERY. "The recurrent laryngeal nerve, as it ascends in the tracheo-oesophageal groove, is overlapped by the lateral lobe of the thyroid gland, and here comes into close relationship with the inferior thyroid artery as this passes medially, behind the common carotid artery, to the gland" (Ellis) E. always results in hoarseness - false: "Unilateral paralysis produces a slight hoarseness which usually disappears as a result of compensatory over-adduction of the opposite normal cord." (Ellis) - All of the muscles are supplied by the recurrent laryngeal nerve, except for cricothyroid muscle, which is supplied by the external laryngeal nerve. Posterior cricoarytenoid is the principal abductor of the vocal folds. ➚ Internal Branch ● SENSORY above cords Superior + inferior epiglotis ➚ Laryngeal N. ➘ External Branch ● MOTOR to cricothyroid 'eee' VAGUS ➘ Recurrent Laryngeal N. ● ALL intrinsic muscles EXCEPT cricothyroid SENSORY SUPPLY OF LARYNX GLOSSOPHARYNGEAL ❚❚❚❚❚❚❚❚❚❚❚❚❚❚❚❚❚ ------------------- EPPIGLOTTIS INTERNAL BRANCH OF SNL ■■■■■■■■■■■■■-------------------- VOCAL CORDS ■■■■■■■■■■■■■ RECURRENT LARYNGEAL ----------- |
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NN28 ANZCA version [Aug99] [Mar00] [Jul00] [2001-Aug] Q27, [2003-Apr] Q34, [2003-Aug] Q41
The feature indicated by the line 'X' is the A. cuneiform cartilage B. vestibular fold C. vallecula D. corniculate cartilage E. arytenoid cartilage |
A. cuneiform cartilage
~~ The Cuneiform is Anterior to the Corniculate, which sits atop the Arytenoid Cartilage ----------- |
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NN29 ANZCA version [Mar95] [Aug95] [Apr96] [Aug96] [Apr97] [Jul97] [Apr98] [Apr99] [2002-Mar] Q28, [2002-Aug] Q14, [2004-Apr] Q29, [2004-Aug] Q58
The second cervical nerve root A. passes between the transverse process of the axis (C2) and C3, to emerge and divide into anterior and posterior primary rami B. contributes fibres through the anterior primary ramus which go on to form the greater occipital nerve C. can be blocked near the occipital artery at the nuchal line D. can be blocked 1 cm caudad to the mastoid process and 1 cm posterior to the line joining the tip of the mastoid to the anterior tubercle of C6 |
D. can be blocked 1 cm caudad to the mastoid process and 1 cm posterior to the line joining the tip of the mastoid to the anterior tubercle of C6
This is the beginnings of a deep cervical plexus block. Done by drawing a line between the mastoid process and Chassaignac’s tubercle and the plotting a line from the lower border of the mandible, corresponding to C4. Equidistant from the C4 to the mastoid will be C3 and C2. - passes between C1 & C2 - contributes fibres through the medial primary ramus which go on to form the greater occipital nerve -- Wiki: A. passes between the transverse process of the axis (C2) and C3, to emerge and divide into anterior and posterior primary rami - false: It passes between C1 and C2. B. contributes fibres through the anterior primary ramus which go on to form the greater occipital nerve - false: the greater occipital nerve is formed by the posterior ramus of C2 (Ellis pp143-144) C. can be blocked near the occipital artery at the nuchal line - unsure: "The nerve (?C2/?Greater occipital) is blocked by injecting local anaesthetic just medial to the occipital artery at a point one-third of the distance between the greater occipital prominence and the mastoid process.". FALSE - see Stan's notes. This is the greater occipital nerve block. D. can be blocked 1 cm caudad to the mastoid process and 1 cm posterior to the line joining the tip of the mastoid to the anterior tubercle of C6 - looks true: "Blockade of the deep cervical plexus is achieved by depositing small (3–5 ml) volumes of local anaesthetic near the transverse processes of the 2nd, 3rd and 4th cervical vertebrae (C2–4). With the patient in the supine position and the head turned away from the side to be blocked, the mastoid process and the transverse process of C6 (at the level of the cricoid cartilage, the most prominent of the cervical transverse processes) are identified, and a line is drawn between them. The roots of the cervical plexus lie beneath this line. The transverse process of C2 is 1.5–2.0 cm distal to the tip of the mastoid process, that of C4 is approximately midway between the clavicle and the mastoid process, that of C3 lies midway between the transverse processes of C2 and 4" ----------- |
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NN31 ANZCA Version [Jul06] Q11
Fibres contained in the recurrent laryngeal nerve include A. motor supply to the crico-thyroid muscles B. motor supply to the crico-arytenoid muscles C. sensory fibres from the epiglottis D. sensory fibres from the crico-thyroid joint E. Sensory fibres from the supra-glottic mucosa |
B. motor supply to the crico-arytenoid muscles
All of the muscles are supplied by the recurrent laryngeal nerve, except for cricothyroid muscle, which is supplied by the external laryngeal nerve. Posterior cricoarytenoid is the principal abductor of the vocal folds. - Nerve supply to the larynx 1. Superior laryngeal nerve - a branch of the inferior ganglion of the vagus (CN X). Has two branches: Internal Laryngeal nerve sensory to laryngeal mucosa above vocal folds, including their superior surface External Laryngeal nerve motor supply to crico-thyroid muscle also motor supply to inferior constrictor of the pharynx (outside the larynx) 2. Recurrent laryngeal nerve - also a branch of the vagus (CN X): All muscles except crico-thyroid muscle Sensation below the vocal folds including their inferior surface NB terminal branches of the recurrent laryngeal nerve are known as the inferior laryngeal nerve ----------- |
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NN32 [Apr07] [Jul07][Apr08] [Mar10][Aug10][Sep11] [Mar12]
Stellate ganglion is where: A. at the level of the body of C6 (spine of C6) B. posterior to the brachial plexus sheath C. anterior to the dome of the pleura D. anterior to the thoracic duct E. anterior to scalenius anterior |
E. anterior to scalenius anterior
The stellate ganglion refers to the ganglion formed by the fusion of the inferior cervical and the first thoracic ganglion as they meet anterior to the vertebral body of C7. It is present in 80% of subjects. It usually lies on or above the neck of the first rib. Relations of stellate ganglion ➭ Anterior The structures anterior to the ganglion include the skin and subcutaneous tissue, the sternocleidomastoid and the carotid sheath. The dome of the lung lies anterior and inferior to the ganglion. ➭ Medial The prevertebral fascia, vertebral body of C7, oesophagus and thoracic duct lie medially. ➭ Posterior Structures posterior to the ganglion include the longus colli muscle, anterior scalene muscle, vertebral artery, brachial plexus sheath and neck of the first rib. ----------- |
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NN33 [Apr07] [Jul07]
Picture of a view of laryngoscopy showing epiglottis, arytenoids and about 1/3 of the black hole of the trachea, asking for which Cormack-Lehane grade: A. 1 B. 2 C. 3 D. 4 E. 5 |
B. 2
Grade I: complete glottis visible Grade II: anterior glottis not seen Grade III: epiglottis seen, but not glottis Grade IV: epiglottis not seen ----------- |
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NS01 ANZCA version [Aug91] [Mar93] [2002-Aug] Q15
The first cervical vertebra has A. two spinous processes B. an odontoid process C. no anterior tubercle D. a facet on its anterior arch E. no foramen transversarium |
D. a facet on its anterior arch
- Has an articular facet for the dens on posterior aspect of anterior arch. Has an anterior tubercle. Has a posterior tubercle instead of spinous process. Has a transverse foramen on each side. Odontoid process = dens, so on C2. ----------- |
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NS08 [1987] [Mar91] [Aug99] [Mar00]
The dura mater: A. Terminates at the second sacral vertebrae with filum terminale tethering it down B. Has its closest relation to the thoracic cord C. Extends into the sclerae D. Arteries lie external to the cranial dura |
A. Terminates at the second sacral vertebrae with filum terminale tethering it down
B. Has its closest relation to the thoracic cord C. Extends into the sclerae ----------- |
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NS13 ANZCA version [1985] [Mar94] [Aug94] [Aug95] [2001-Aug] Q95
Sensations transmitted by the cuneate fasciculus include 1. touch 2. pain 3. position sense 4. temperature sensation |
1. touch
3. position sense Posterior columns - fine touch & proprioception Lateral columns (spinothalamic tract) - pain & temperature The Fasciculus cuneatus transmits fine touch, fine pressure, vibration and proprioception information from spinal nerves located in dermatomes C1 through T6. The fasciculus gracilis (tract of Goll) is a bundle of nerve fibres in the spinal cord that carries information about fine touch from the lower part of the body. http://faculty.etsu.edu/currie/images/neuro2.jpg ----------- |
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NS15b ANZCA version [2003-Apr] Q28, [2003-Aug] Q68, [Jul05] [Mar06] [Oct08]
Anatomical features of the spinal cord do NOT include A. an anterior median fissure and a posterior median septum B. thirty-two pairs of spinal nerves C. a filum terminale ending at the coccyx D. four to six spinal arteries arising from the posterior inferior cerebellar arteries E. the anterior spinal artery arising from the vertebral arteries |
B. thirty-two pairs of spinal nerves
There are 31 pairs of spinal nerves: 8 cervical, 12 thoracic, 5 lumbar, 5 sacral and 1 coccygeal. Much debated on wiki… D may also be true, but B>D ----------- |
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NS21 ANZCA version [2003-Apr] Q120
Which of the following sequences best indicates the order of structures in the path of a needle inserted in the midline for placement of a spinal anaesthetic? A. interspinous ligament, supraspinous ligament, ligamentum flavum, epidural space, dura mater, arachnoid mater B. supraspinous ligament, interspinous ligament, ligamentum flavum, epidural space, dura mater, arachnoid mater C. supraspinous ligament, interspinous ligament, ligamentum flavum, epidural space, dura mater, pia mater D. supraspinous ligament, ligamentum flavum, interspinous ligament, epidural space, dura mater, arachnoid mater E. supraspinous ligament, ligamentum flavum, interspinous ligament, epidural space, dura mater, pia mater |
B. supraspinous ligament, interspinous ligament, ligamentum flavum, epidural space, dura mater, arachnoid mater
~~ Supraspinous ligaments – tough fibrous column that connects the tips of the spinous processes Interspinous ligaments – connect the shafts of the spinous processes Ligamenta flava – series of thick, elastic, vertical fibres that connect adjacent vertebral laminae Posterior longitudinal ligament – extends along the posterior aspect of the vertebral bodies and discs Anterior longitudinal ligament – runs along the anterior surface of the vertebral bodies, from C2 to the sacrum. It adheres to the anterior surface of the vertebral bodies and the discs ----------- |
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NS22 ANZCA VERSION [Jul07][Apr08]
Regarding spinal cord blood supply, the A. anterior spinal artery arises from the posterior inferior cerebellar arteries B. anterior spinal artery supplies 50% of the spinal cord, while the posterior spinal arteries supply 25% each C. largest radicular artery is usually in the lumbar region D. posterior spinal arteries are only supplied by radicular arteries E. upper cervical segment of the spinal cord receives most of its blood flow from the vertebral arteries |
E. upper cervical segment of the spinal cord receives most of its blood flow from the vertebral arteries
- A: False…anterior spinal artery arises from a branch from each vertebral artery B: False…anterior artery supplies anterior 2/3 of the spinal cord while the posterior arteries supply the remaining 1/3 C: Probably false…most references state it is usually from low thoracic or high lumbar. Wikipedia states in 75% of people it arises from between T9 and T11 D: False…posterior spinal arteries arise from PICA E: True…anterior spinal artery is from vertebrals, posterior spinal artery is from PICA which comes off vertebrals, and the segmental medullary arteries in the neck branch off the vertebrals as well ~~ Arterial Supply of Spinal Cord: ● Anterior spinal artery – formed by the union of the vertebral arteries at the foramen magnum. It runs on the anterior median issure and supplies the larger part of the anterior spinal cord ● Posterior spinal arteries (one or two on each side) – formed from the posterior cerebellar arteries. These are smaller and reinforced by spinal branches from a number of nearby vessels ● Radicular arteries also provide further blood supply to both the anterior and posterior spinal arteries. These arise from the cervical, thoracic and lumbar regions (usually number between three and six larger vessels). One vessel is often particularly large – arteria radicularis magna (also known as artery of Adamkiewicz). It usually arises distally and from the left, and may provide the dominant supply to the lower two-thirds of the spinal cord Despite the extensive origin, the arterial blood supply of the spinal cord is vulnerable. The anterior and posterior spinal arteries do not have direct anastomoses and cord infarction is possible after thrombosis, hypotension, surgical occlusion, trauma, and vasoconstriction. In a study of approximately 70 people that examined the spinal cord's blood supply it was found that[7]: 1. The Adamkiewicz artery sometimes arises from a lumbar vessel. 2. In approximately 30% of people it arises from the right side. 3. One quarter of people have two large anterior segmental medullary arteries. ----------- |
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NT07 [1986] [1987] [1988] [Jul00]
With regard to the segmental bronchi: A. There are 10 on the right B. The left apical and the posterior come off as one C. Apical and posterior in lower lobes pass backwards D. There are 8 on the left E. The middle lobe bronchus and medial basal arise from the lower lobe bronchus |
A. There are 10 on the right
?B. The left apical and the posterior come off as one ?C. Apical and posterior in lower lobes pass backwards 10 on the right (3/2/5), 10 on left (5/5 with 2 in lingula) ----------- |
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NT17 ANZCA version [1987] [1988] [Mar92] [Aug92] [2001-Apr] Q113
The atrioventricular node 1. is usually supplied by a branch of the right coronary artery 2. derives its blood supply from the circumflex coronary artery in about 10% of patients 3. slows electrical conduction from the atria to the ventricles 4. is bypassed by one or more accessory conduction pathways in the bradycardia-tachycardia syndrome |
1. is usually supplied by a branch of the right coronary artery
2. derives its blood supply from the circumflex coronary artery in about 10% of patients 3. slows electrical conduction from the atria to the ventricles ----------- |
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NT20 ANZCA version [Aug91] [Aug99] [2004-Apr] Q51
The term "base" of the heart refers to the A. diaphragmatic surface of the heart B. left ventricle and left atrium C. right ventricle and right atrium D. left and right atrium E. roots of the great vessels and intervening heart walls |
D. left and right atrium
- "The base, or posterior surface (Fig. 59), is quadri- lateral in shape and is formed mainly by the left atrium with the openings of the pulmonary veins and, to a lesser extent, by the right atrium." - Ellis. ----------- |
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NT22b [Mar00]
Dome of the lung: A. Fibrous covering attached to transverse process of C7 B. Notched by subclavian vein C. Related to medial 1/3rd of clavicle D. Rises to 2.5 mm above posterior first rib |
A. Fibrous covering attached to transverse process of C7
C. Related to medial 1/3rd of clavicle Sibson’s fascia, the suprapleural membrane, also adherent to the inner border of the first rib. Apex of lung AND cupula of pleura both rise about 3-4 cm above medial 1/3 clavicle and ant end of first rib. Due to oblique nature of thoracic inlet, don't rise above post rib. Oblique nature gives rise to funny pleural shape. The fibrous covering attached to the transverse process of C7 is the suprapleural membrane, which is a dense fascia layer that strengthens the cupula. THis is also attached to the internal border of the first rib as well as the ant border of the transverse process of C7 vertebra. This membrane contains some scalenus minimus muscle to give some strength. The cupola is strengthened by a thickening of the endothoracic fascia termed the suprapleural membrane, which is attached to the inner margin of the first rib and the transverse process of the seventh cervical vertebra (C.V.7). Some muscular fibers (scalenus minimus) may be inserted into the membrane. Because of the slope of the first rib, the cupola of the pleura and the apex of the lung project upward into the neck, posterior to the sternomastoid, and hence may be injured in wounds of the neck. Their highest point is 2 to 3 cm or more above the level of the medial third of the clavicle. The sympathetic trunks and first thoracic nerves are found posterior to the cupola. http://www.dartmouth.edu/~humananatomy/part_4/chapter_22.html ----------- |
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NT32 ANZCA version [Aug94] [2001-Apr] Q5, [2001-Aug] Q23, [2004-Apr] Q17, [2004-Aug] Q9
In this diagram of the superior surface of a first rib A. label 'W' represents the insertion point of scalenus posterior B. label 'X' represents the groove for the subclavian vein C. a supraclavicular brachial plexus block needle is inserted posterior to the point labeled 'Y' D. label 'Z' represents the insertion point of scalenus anterior E. label 'W' represents the groove for the subclavian artery |
C. a supraclavicular brachial plexus block needle is inserted posterior to the point labeled 'Y
- See Ellis pg 300 ----------- |
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NT33 ANZCA version [2004-Aug] Q21
With regard to bronchopulmonary segments A. there are 10 each on each side with two segments in the lingula and three segments in the right middle lobe B. there are 9 on the left side and 10 on the right side with two segments in the lingula and three segments in the right middle lobe C. there are 10 on each side with five segments in the right lower lobe and four segments in the left lower lobe D. there are 9 on the left side and 10 on the right side with five segments in the right lower lobe and four segments in the left lower lobe E. there are 10 on each side with two segments in the lingual and two segments in the right middle lobe |
D. there are 9 on the left side and 10 on the right side with five segments in the right lower lobe and four segments in the left lower lobe
( accroding to ELLIS) OR E. there are 10 on each side with two segments in the lingual and two segments in the right middle lobe (Previos Grp said E) - 10 on the right (3/2/5) like the BMW 325, 10 on left (5/5 with 2 in lingula) ~~ for Toby Tang's analysis: 10 lobes == 10 fingers - if you have an upper lobectomy, it makes no difference in long term "anatomical" means "how it looks when you scope it - i.e. how many tertiary bronchi" ----------- Its tricky because functionally there are 10 bronchopulmonary segments on each side but anatomically, there are only 8 on the left. The apico-posterior and the antero-medial on the left are fused...ie 2 bananas in 1 banana peel thing that was in RJ Last. So, let see: A. Wrong because the RML only has 2 segments (like its counterpart - the lingula) B. Wrong too. C. Probably wrong as they said are mixing func and anatomical segments...ie not internally consistent. It should be 10 on the right, 8 on the left with 5 in the RLL and 4 in the LLL. It would also be correct to talk about functional segments - ie 10 on each side, 3 in the upper lobes, 2 in the lingula and RML and 5 in the lower lobes. D. Probably wrong... 8 or 10 on Left and 1o on the right. E. Potentially correct. Therefore E is the correct answer. |
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NT34b ANZCA version [Apr99] [2002-Aug] Q75, [2004-Apr] Q89, [Mar06] [Jul06][Apr08][Oct08]
The intercostal nerves A. arise as the sensory fibres of the anterior primary rami from their spinal segments B. give off a lateral cutaneous branch at the angle of the rib C. lie in the subcostal groove in only 50% of people D. lie between the intercostalis intimi and the pleura E. are enclosed in a dural sheath from their origin to the angle of the rib |
C. lie in the subcostal groove in only 50% of people
- See big wiki debate. ----------- |
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NT35 ANZCA Version [Jul06] Q127
Regarding thoracic anatomy, the A. aorta passes through the diaphragm posteriorly at T10 B. carina most commonly lies at T4 in the adult C. lungs compromise 16 bronchopulmonary segments in total D. oblique fissures runs along the 6th rib on both sides E. right main bronchus runs 45° to the vertical |
B. carina most commonly lies at T4 in the adult
- the trachea bifurcates at the T4 level" = Angle of Louis ----------- Levels at which various structures pass through diaphragm: * T8 IVC, phrenic n - obviously the compressible vein mut go thru the tendinous part, not the muscular part, so it will be central and thus high * T10 oesophagous, vagi, L gastric a. and v. * T12 aorta, thoracic duct, azygous vein B: True: "the trachea bifurcates at the T4 level" = Angle of Louis C is wrong- (see NT33 for bronchopulmonary segments); There is 19 or 20 depending on whether you count the Left Medial Basal Segment or not. D is wrong E: "the right main bronchus is shorter, wider and more vertical than the left (25deg). After 2.5cm it gives off the R upper bronchus. The left main bronchus is more angled 45deg and is 5cm long" |
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Rpt: Dural Sac ends at what level in a neonate?
A. L1 B. L3 C. L5 D. S1 E. S3 |
E. S3
- ----------- |
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TMP-Mar11-025
The anterior branch of the femoral nerve supplies everything but: A: pectinius B: rectus femoris C: Medial thigh D: anterior thigh E: sartorius |
B: rectus femoris
- From Anatomy for Anaesthetists: The femoral nerve (L2-4) is the largest nerve of the lumbar plexus and supplies the muscles and the skin of the anterior compartment of the thigh. The nerve emerges from the lateral margin of psoas, passes downwards in the groove between psoas and iliacus (to both of which it send a nerve supply), then enters the thigh beneath the inguinal ligament. At the base of the femoral triangle, the nerve lies on iliac us, a finger's breadth lateral to the femoral artery, from which vessel it is separated by a portion of the psoas. Once within the triangle, the nerve breaks up into its TERMINAL branches which stem from the ANTERIOR and POSTERIOR division. ANTERIOR división - Muscular branches to: PECTINEUS and SARTORIUS - Cutaneous branches: Intermediate cutaneous nerve of thigh (supplies front of the thigh down to the knee); medial cutaneous nerve of thigh (divides into anterior branch which supply medial lower thigh and posterior branches which supply medial side of leg with obturator and saphenous nerves) Posterior division - muscular branches to QUADRICEPS FEMORIS - cutaneous branch - saphenous nerve. - articular branches to hip and knee. ----------- |
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TMP-Mar12-011
What is the distance from the lips to the carina in an 70kg adult male in cm a. 21 b. 23 c. 25 d. 27 e. 29 |
D. 27cm??? or E?
DLT length is 29cm (to go into bronchus)... -- Height is a better correlation for this distance rather than weight. 'lips' not defined - do they mean mid-incisor or angle of the mouth? From this abstract "Anesthesiology 2007; 107: A943" The recommended depth of ETT placement is 21 in females and 23 from males when measured midline from incisors. The tip should remain 5+/2cm above carina. After placement, ETT is frequently shifted from mid incisor to angle of mouth. Lip to carina distance decreased 1.34+/- 0.69cm in females and 1.36+/-0.64cm in males when moving the tube from midline to the angle of the mouth. ----------- |
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TMP-Sep11-078
Lumborsacral nerve (roots) does not supply: A. Subcostal nerve B. Ilioinguinal n C. Iliohypogastric n D. Femoral n E. Genitofemoral n (?) |
A. Subcostal n.
Subcostal is T12 ----------- |
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NZ03 ANZCA version [2003-Aug] Q123, [2004-Apr] Q79, [Apr07] [Oct08][Oct09][Mar10]
Pre-ganglionic sympathetic fibres pass to the A. otic ganglion B. carotid body C. ciliary ganglion D. coeliac ganglion E. all of the above |
D. coeliac ganglion
- Somatic nerves all get postganglionic. Head and neck receives postganglionic fibres from the sympathetic chain. The VISCERAL plexuses: coeliac, hypogastric and pelvic receive preganglionic via splanchnic nerves to supply postgangionic to viscera (except adrenal medulla). Ellis et al pg 221. - It receives both pre and post ganglionic sympathetic fibers. The ciliary and otic ganglia are parasympathetic ganglia which receive pre-ganglionic parasympathetic fibers but post-ganglionic sympathetics. The carotid body is a sensory organ that transmits afferents to the CNS ----------- |
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NN13c ANZCA version [Apr97] [2002-Mar] Q105, [2002-Aug] Q140
Regarding the anatomy of the larynx 1. the cricothyroid muscles are cord tensors 2. the superior laryngeal artery accompanies the recurrent laryngeal nerve 3. the vagus nerve supplies motor fibres to all the intrinsic muscles of the larynx 4. the posterior cricoarytenoid muscles are adductors of the cords |
1. the cricothyroid muscles are cord tensors
3. the vagus nerve supplies motor fibres to all the intrinsic muscles of the larynx ----------- |
