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Section 1

Lower Limbs mcqs

1) Tensor fasciae latae is supplied by :


a) anterior division of femoral nerve
b) superior gluteal nerve
c) nerve to vastus lateralis
d) inferior gluteal nerve
e) lateral femoral cutaneous nerve

2) Which structure is intrasynovial at the knee joint:


a) oblique popliteal ligament
b) tendon of popliteus
c) medial and lateral menisci
d) anterior cruciate ligament
e) none of the above

3) The ‘screw-home’ movement in extension of the knee joint begins with tightening of the:
a) anterior cruciate ligament
b) oblique popliteal ligament
c) medial collateral ligament
d) lateral collateral ligament
e) posterior cruciate ligament

4) Tibialis anterior:
a) is supplied by the tibial nerve
b) inserts into the second metatarsal bone
c) is pierced by the posterior tibial artery
d) tendon perforates the superior extensor retinaculum
e) does not arise from the interosseous membrane

5) The adductor canal:


a) contains the femoral artery and nerve
b) ends distally in the adductor longus hiatus
c) contains no muscular nerves
d) has adductor longus forming the root
e) always has the femoral artery lying between the saphenous nerve and the femoral vein

6) The great saphenous vein:


a) joins the femoral vein above the inguinal ligament
b) begins as the upward continuation of the lateral marginal vein of the foot
c) travels with the saphenous nerve along its course
d) runs behind the medial malleolus
e) enters the femoral vein on its anteromedial side
7) Regarding the femoral artery:
a) adductor magnus lies between it and the profunda femoris artery
b) the profunda femoris vein lies behind the profunda femoris artery
c) profunda femoris artery arises from its posterior surface
d) the lateral circumflex femoral artery separates the superficial and deep branches of the femoral nerve
e) the femoral vein is always on its medial side

8) Gluteus maximus:
a) forms the gluteal fold
b) has four bursae beneath it
c) has blood supply solely from the inferior gluteal artery
d) is the chief control of hip flexion
e) has 50% of fibres inserting into the gluteal tuberosity
9) Regarding the adductor compartment:
a) adductor magnus lies between the anterior and posterior divisions of the obturator nerve
b) adductor longus inserts into the upper two thirds of the linear aspect of the femur
c) the hamstring part of adductor magnus is supplied by the tibial part of the sciatic nerve
d) the medial intermuscular septum separates the adductor compartment from the posterior compartment
e) obturator externus medially rotates the hip

10) Which vessel is NOT involved in the trochanteric anastomosis?


a) superior gluteal artery
b) obturator artery
c) lateral circumflex femoral artery
d) medial circumflex femoral artery
e) inferior gluteal artery

11) The sciatic nerve:


a) lies deep to the posterior femoral cutaneous nerve
b) passes down over obturator internus, quadratus, femoris and piriformis
c) tibial and common peroneal components separate behind the hip joint
d) in the buttock it lies midway between the greater trochanter and pubic tuberosity
e) is derived from L3, 4, 5, S1, 2

12) Which is the odd one out?


a) sciatic nerve
b) nerve to obturator internus
c) superior gluteal nerve
d) pudendal nerve
e) posterior femoral cutaneous nerve

13) Regarding the hamstring compartment:


a) the cutaneous nerve supply is from the posterior circumflex femoral nerve
b) ischial fibres of adductor magnus degenerate to form the tibial collateral ligament
c) semitendinosus lies deep to semimembranosus
d) the oblique popliteal ligament is an expansion of biceps femoris
e) the long head of biceps arises from the lateral facet of the ischial tuberosity
14) Regarding the popliteal vessels:
a) the tibial nerve lies between the popliteal artery and vein
b) the sural arteries supply soleus
c) the middle genicular artery supplies the cruciate ligaments
d) lymph nodes lie alongside the popliteal artery
e) the popliteal artery enters the fossa on the lateral side of the femur

15) At the knee joint:


a) the fibular collateral ligament is attached to the lateral meniscus and joint capsule
b) there are three main gaps in the joint capsule
c) the tibial collateral ligament is tight in flexion
d) the posterior cruciate ligament is attached to the lateral condyle of the femur
e) the cruciate ligaments are sensitive and the menisci are not

16) Regarding nerve supply of the lower limb:


a) superficial peroneal nerve supplies the muscles in the anterior compartment of the leg
b) the cruciate ligaments are supplied by the tibial nerve
c) the obturator nerve supplies obturator internus muscle
d) the sciatic nerve does not make contact with bone
e) the tibial part of the sciatic nerve is the sole supply to muscles in the hamstring compartment

17) Regarding flexor digitorum longus:


a) its four tendons divide under the flexor retinaculum
b) it arises from the tibia and interosseous membrane only
c) the medial two tendons receive a strong slip from the tendon of flexor hallucis longus
d) the tendons have no flexor sheaths
e) it inserts into the bases of the middle phalanges

18) The following are branches of the femoral artery except:


a) superficial circumflex iliac artery
b) superficial epigastric artery
c) superficial external pudendal artery
d) deep external pudendal artery
e) middle genicular artery

19) The following cutaneous nerves of the thigh are derived in part form the second lumbar nerve except::
a) ilioinguinal
b) medial femoral cutaneous nerve
c) obturator nerve
d) lateral femoral cutaneous nerve
e) genitofemoral nerve

20) Which of the following, regarding the great saphenous vein, is INCORRECT?
a) it is the longest vein in the body
b) it passes behind the medial malleolus
c) at the knee, it lies a hand’s breadth behind the medial border of the patella
d) the saphenous opening lies about 3cm below and lateral to the pubic tubercle
e) the deep external pudendal artery runs medially behind the saphenous vein near its termination
21) Which of the following is CORRECT regarding lymphatic drainage of the lower limb?
a) the superficial inguinal node group consists of about 15 nodes
b) the lateral nodes of the proximal superficial group receive lymph from the buttock, flank and back
below the waist
c) the medial nodes of proximal superficial group receive lymph from testes, glans penis, lower anal canal
and perineum
d) the distal nodes of the superficial group receive all the superficial lymphatics of the lower limb
e) the superficial inguinal nodes drain mainly to the internal iliac nodes

22) Fascia lata is not:


a) attached inferiorly to the tibial condyles and head of the fibula
b) reinforced anteriorly by expansions from the quadriceps tendon
c) attached to Scarpa’s fascia above the inguinal ligament
d) continuous below the popliteal fossa into the deep fascia of the calf
e) attached superiorly along the external lip of the iliac crest

23) The iliotibial tract:


a) lies lateral to tensor fascia latae
b) inserts onto the head of the fibula
c) is the origin of 60% of gluteus maximus
d) is a weak flexor of the knee via tensor fascia latae
e) is attached superiorly to the iliac crest

24) Which of the following muscles is not found in the floor of the femoral triangle?
a) iliacus
b) psoas
c) pectineus
d) adductor magnus
e) adductor longus

25) Which of the following is not found within the femoral sheath?
a) femoral artery
b) femoral canal
c) femoral hernia
d) femoral nerve
e) lymph node of Cloquet

26) The profunda femoris artery does not:


a) normally supply all the thigh muscles
b) arise from the lateral side of the femoral artery, 3-4cm distal to the inguinal ligament
c) give off the deep external pudendal artery
d) lie behind the profunda vein
e) lie directly anterior to adductor brevis and magnus
27) Which of the following is INCORRECT regarding the femoral nerve?
a) is formed from the anterior divisions of the anterior rami of the lumbar nerves 2, 3 and 4
b) supplies iliacus in the abdomen
c) lies in the iliac fossa between psoas and iliacus
d) gives a branch to pectineus as it enters the femoral triangle
e) divides into several branches just distal to the inguinal ligament

28) All the following are branches of the femoral nerve except:
a) medial femoral cutaneous nerve
b) saphenous nerve
c) nerve to vastus medialis
d) lateral femoral cutaneous nerve
e) nerve to sartorius

29) Which factor is most important in preventing lateral displacement of the patella during quadriceps
contraction?
a) the forward prominence of the lateral condyle of the femur
b) the action of articularis genu
c) the action of vastus medialis
d) the action of rectus femoris
e) the tension of the medial patellar retinaculum

30) The adductor canal is not:


a) roofed by fascia containing the subsartorial plexus
b) occupied by the sciatic nerve
c) also known as Hunter’s canal
d) occupied by the femoral artery
e) a gutter shaped groove between vastus medialis and the front of the adductor muscles

31) Which of the following is INCORRECT regarding the adductor canal?


a) sartorius lies on the fascial roof
b) in the distal part of the canal, the femoral vein is posterolateral to the artery
c) at all levels, the artery lies between saphenous nerve and femoral vein
d) the subsartorial plexus supplies overlying fascia lata and an area of skin above medial side of the knee
e) the adductors in the floor of the canal are the adductor brevis above and the adductor longus below

32) In the medial compartment of the thigh:


a) adductor magnus consists of adductor and hamstring muscle masses
b) the contents are separated from the posterior compartment by the posterior intermuscular septum
c) adductor longus is the most superficial muscle of the medial side of the thigh
d) the anterior division of the obturator nerve passes through obturator externus
e) the posterior division of the obturator nerve is the prime motor supply

33) With respect to the posterior compartment of the thigh:


a) blood supply is mainly from the femoral artery
b) the sciatic nerve lies lateral to the long head of biceps
c) the long head of biceps is supplied by the common peroneal nerve
d) the hamstrings form the apex of the popliteal fossa
e) semimembranosus arises in common with the long head of biceps
34) Slipped upper femoral epiphysis:
a) is more common in girls than boys
b) usually occurs in the 5-8 year age group
c) may present as referred pain in the knee
d) the limb may be internally rotated and shortened
e) can be treated conservatively

35) Dermatomes of lower limb:


a) S1 supplies the great toe
b) L2 supplies anterior upper thigh
c) S3 supplies perianal area
d) L4 supplies medial thigh
e) L5 supplies medial calf

36) Muscles in the floor of the femoral triangle include all EXCEPT:
a) adductor magnus
b) pectineus
c) psoas
d) ilacus
e) adductor longus

37) Patellar plexus comprises of all EXCEPT:


a) posterior branch of lateral femoral cutaneous nerve
b) infrapatella branch of saphenous nerve
c) medial femoral cutaneous nerve
d) anterior branch of lateral femoral cutaneous nerve
e) intermediate femoral cutaneous nerve

38) The most medial structure passing under the inferior extensor retinaculum of the foot is:
a) deep peroneal nerve
b) tibialis anterior
c) extensor hallucis longus
d) anterior tibial artery
e) peroneus brevis

Lower Limb - Answers


1 B 14 C 27 A
2 E 15 E 28 D
3 A 16 B 29 C
4 D 17 C 30 B
5 E 18 E 31 E
6 E 19 A 32 A
7 D 20 B 33 D
8 D 21 B 34 C
9 C 22 C 35 B
10 B 23 E 36 A
11 A 24 D 37 A
12 C 25 D 38 B
13 B 26 C
Section 2
Lower Limbs
1) Cutaneous nerve supply of the thigh involves all but which of the following:
a) the intermediate femoral cutaneous nerve
b) the obturator nerve
c) the genital branch of the genitofemoral nerve
d) the ilioinguinal nerve
e) the posterior cutaneous nerves of the thigh

2) The patellar plexus takes twigs from all but which of the following?
a) infrapatellar branch of the common peroneal nerve
b) medial femoral cutaneous nerve
c) lateral femoral cutaneous nerve
d) intermediate femoral cutaneous nerve
e) infrapatellar branch of the saphenous nerve

3) The inferior gluteal nerve supplies:


a) gluteus maximus
b) gluteus medius
c) gluteus minimus
d) all of the above
e) none of the above

4) Within the buttock:


a) the pudendal nerve emerges beneath piriformis, turns around the back of the sacrospinous ligament
and passes between the sacrotuberous and sacrospinous ligaments
b) the internal pudendal artery can be compressed against the base of the ischial tuberosity
c) the sciatic nerve (L4, 5, S1) emerges from below piriformis muscle more laterally than the inferior gluteal
and pudendal nerves and vessels
d) the posterior femoral cutaneous nerve lies medially to the sciatic nerve
e) the cruciate anastomosis provides the main source of blood for the supply of the head of femur

5) With respect to the ligaments around the knee joint:


a) the fibular collateral ligament blends with the capsule and is attached to the lateral meniscus
b) the tibial collateral ligament blends posteriorly with the capsule and is attached to the medial meniscus
c) the oblique popliteal ligament is an expansion from the tendon of semitendinosis that blends with the
capsule posteriorly
d) the posterior cruciate ligament runs from anterior tibial plateau to the posteromedial aspect of the
lateral femoral condyle
e) the transverse ligament runs posteriorly between menisci

6) With respect to the posterior compartment of the leg, which is FALSE?


a) plantaris arises from the lower part of the lateral supracondylar line and is absent in 10%
b) the medial head of gastrocnemius is larger than the lateral
c) the small saphenous vein drains the medial side of the dorsal venous arch and medial margin of the
foot
d) the soleal muscle contains a rich plexus of small veins → the soleal pump
e) the nerve of this compartment is the tibial nerve
7) The myotome for plantar flexion of the great toe is:
a) L3, 4
b) L4, 5
c) L5, S1
d) S1, 2
e) S2, 3

8) With respect to the hip bone:


a) the pelvic rim is formed by the iliac crest, top curricular area and pectineal line
b) the iliofemoral ligament and sartorius are attached to/at (??) the anterosuperior iliac spine
c) the iliopubic eminence on anterior margin of acetabulum joins the ischium and pubic bone
d) the tubercle of the iliac crest lies 7.5cm behind the anterosuperior iliac spine
e) the line between the highest point of the iliac crest passes through the spine of ??????

9) Which of the following structures is NOT found in the adductor (subsartorial) canal?
a) femoral artery
b) femoral vein
c) femoral nerve
d) saphenous nerve
e) nerve to vastus medialis

10) The surface markings of the sciatic nerve are from:


a) the ischial tuberosity to the adductor tubercle of the medial femoral condyle
b) the posterior superior iliac spine to the apex of the popliteal fossa
c) the midpoint of a line between the ischial tuberosity and the greater trochanter to the adductor
tubercle of the medial femoral condyle
d) the ischial tuberosity to the apex of the popliteal fossa
e) the midpoint of a line between ischial tuberosity and greater trochanter to apex of the popliteal fossa

11) The femoral canal:


a) is the lateral compartment of the femoral sheath
b) lies medial to the pubic tubercle
c) contains the femoral nerve
d) is medial to the femoral vein
e) transmits the femoral branch of the genitofemoral nerve

12) The great saphenous vein:


a) commences at the medial end of the dorsal venous arch
b) passes behind the medial malleolus
c) is accompanied by the saphenous nerve throughout its course
d) passes under the inguinal ligament and enters the femoral vein
e) drains the medial side of the leg between the tibia and the tendocalcaneus

13) Which is NOT true of the tendoachilles?


a) it inserts into the middle third of the posterior surface of the calcaneus
b) it is invested in a synovial sheath
c) it is formed from the soleus and gastrocnemius
d) a bursa lies between the tendon and the upper third of the calcaneus
e) a bursa lies between it and the deep fascia near its insertion
14) Which of the following structures lies within the knee joint?
a) patellar ligament
b) tibial collateral ligament
c) fibular collateral ligament
d) tendon of popliteus
e) patellar retinacula

15) Following an injury to the leg, a patient is unable to dorsiflex their foot. Which nerve is most likely to be
damaged?
a) the deep branch of the common peroneal nerve
b) the sural nerve
c) the superficial branch of the common peroneal nerve
d) the saphenous nerve
e) none of the above

16) With respect to peroneus longus:


a) it inserts into the base of the 5th metacarpal
b) it is supplied by the superficial peroneal nerve
c) it has a broad tendon that lies between the lateral malleolus and the tendon of peroneus brevis
d) it arises from the upper two thirds of the tibia
e) it is mainly supplied by L4 and L5 segments

17) The stability of the weightbearing flexed knee is maintained by:


a) anterior cruciate ligament
b) iliotibial tract
c) posterior cruciate ligament
d) popliteus and posterior cruciate ligament
e) arcuate popliteal ligament and anterior cruciate ligament

18) Regarding the femoral triangle:


a) the lateral border of the adductor longus makes up its medial boundary
b) it is bisected by the femoral nerve
c) the lateral border of sartorius muscle makes up its lateral boundary
d) the long saphenous vein joins the femoral vein within the triangle
e) rectus femoris makes up part of the floor

19) Inversion of the foot is performed by which pair of muscles?


a) peroneus longus and peroneus brevis
b) peroneus longus and tibialis posterior
c) tibialis anterior and tibialis posterior
d) peroneus brevis and plantaris
e) none of the above

20) The anterior tibial artery:


a) pierces the interosseous membrane
b) supplies the lateral compartment of the leg
c) lies lateral to the deep peroneal nerve
d) lies lateral to tibialis anterior
e) gives the nutrient artery to the tibia

21) The suprapatellar bursa:


a) does not communicate with the knee joint
b) lies in front of the vastus intermedius muscle
c) extends 5cm or more above the patella
d) lies deep to the patellar retinacula
e) none of the above

22) Which of the following does NOT apply to the popliteus muscle?
a) it inserts into the lateral meniscus of the knee joint
b) it is innervated by the tibial nerve
c) it acts to extend the knee joint
d) it inserts into the lateral condyle of the femur
e) it acts to laterally rotate the femur of the fixed tibia

23) A 30 year old man presents with adenopathy of the medial group of superficial inguinal lymph nodes on
the right side. Which of the following is the primary site resulting in this finding?
a) right testis
b) right buttock
c) the skin of the right lower limb
d) the anal canal
e) none of the above

24) Regarding the femoral artery:


a) it enters the thigh directly beneath the deep inguinal ring
b) it lies lateral to the femoral nerve in the femoral sheath
c) it gives rise to the profunda femoris artery which pierces the femoral sheath
d) does not contribute to the trochanteric anastomosis
e) its branches include the superficial epigastric artery and the deep external pudendal artery

25) Regarding the popliteal fossa:


a) the common peroneal nerve passes through the lateral part of the fossa
b) it contains no lymph nodes
c) it has a roof pierced by the tibial nerve
d) the popliteal artery lies superficial to the popliteal vein throughout the fossa
e) the small saphenous vein joins the popliteal vein before its entry into the fossa

26) Regarding the movements at the knee joint:


a) popliteus ‘unlocks’ the extended knee by producing medial rotation of the femur
b) there is no active rotation of the extended knee
c) passive extension of the knee does not result in ‘locking’ of the joint
d) the posterior cruciate ligament prevents backward displacement of the femur on the tibial plateau
e) the major role of the menisci is in flexion/extension of the knee
27) The dorsalis pedis artery:
a) lies medial to the tendon of extensor hallucis longus
b) lies lateral to the detail branch of the deep peroneal nerve
c) crosses superficial to the tendon of extensor hallucis brevis
d) terminates at the arcuate artery
e) joins the lateral plantar artery to form the plantar arch

28) A 25 year old man is unable to plantar flex his foot. The most likely cause is damage to:
a) the superficial peroneal nerve
b) the L5 nerve root
c) the tibial nerve
d) soleus
e) gastrocnemius

29) Which of the following is NOT a component of the second layer of the sole of the foot?
a) tendon of flexor hallucis longus
b) abductor hallucis
c) flexor accessorius
d) the lumbrical muscles
e) tendon of flexor digitorum longus

30) Which of the following structures does NOT pass through the greater sciatic foramen?
a) the sciatic nerve
b) the pudendal nerve and vessels
c) the posterior cutaneous nerve of the thigh
d) the inferior gluteal nerve and vessels
e) the nerve to obturator externus

31) The psoas muscle:


a) passes across the front of the capsule of the hip joint
b) is a powerful lateral rotator of the femur
c) inserts into the greater trochanter
d) is supplied by L4 and L5 nerve roots
e) arises from the iliac crest and sacroiliac joint

32) The femoral nerve:


a) is formed from the anterior divisions of the anterior primary rami of L2-4
b) is formed from the same spinal segments as the obturator nerve
c) divides after passing through the femoral triangle
d) has no cutaneous branches other than the saphenous nerve
e) enters the thigh in the femoral sheath

33) The peroneus longus muscle:


a) passes superficial to the superior peroneal retinaculum
b) inserts into the styloid process of the fifth metatarsal bone
c) is supplied by the common peroneal nerve
d) assists in the maintenance of the lateral longitudinal arch
e) has no origin from the tibia
34) The short saphenous vein:
a) lies anterior to the lateral malleolus
b) is accompanied by the saphenous nerve
c) drains into the great saphenous vein
d) drains the lateral margin of the foot
e) lies deep to the deep fascia of the calf

35) Following a subcapital fracture of the neck of the femur, an 80 year old man sustains avascular necrosis of
the femoral head. This is most likely to be the consequence of interruption to the blood supply to the head
from which of the following sources:
a) arteries from trochanteric anastomosis in the retinacula
b) artery of the ligament of the head from the obturator artery
c) branches from the profunda femoris artery
d) branches from the pudendal artery
e) branches from the inferior gluteal artery

36) Which structure does NOT bass under the inguinal ligament?
a) femoral vein
b) lateral cutaneous nerve of the thigh
c) femoral nerve
d) femoral branch of the genitofemoral nerve
e) great saphenous vein

37) Regarding the femoral triangle:


a) adductor magnus makes up part of the floor
b) no motor branches of the femoral nerve leave the triangle to enter the sartorius canal
c) the femoral artery occupies the lateral compartment of the femoral sheath
d) the main cutaneous nerve supply of the skin overlying the triangle is by the ilioinguinal nerve
e) the femoral vein lies medial to the femoral artery throughout the triangle

38) Regarding the femoral nerve, all of the following are true EXCEPT:
a) the superficial group consists of two cutaneous and two muscular branches
b) the nerve to the vastus medialis passes down on the medial side of the femoral artery
c) the medial femoral cutaneous nerve belongs to the superficial group
d) the saphenous nerve is the only cutaneous branch of the deep group of the femoral nerve
e) the femoral nerve is formed from the posterior divisions of the ventral rami of the lumbar nerves 2, 3
and 4

39) Regarding the hip joint all of the following statements are true ????EXCEPT:
a) the anterior fibres of the gluteus medius and minimus act as medial rotator of the hip joint
b) the gluteus maximus is the most powerful lateral rotator of the hip joint
c) gluteus medius and minimus are supplied by the inferior gluteal nerve (L5, S1, S2)
d) the superior gluteal nerve (L4, L5, S1) emerges from the greater sciatic notch
e) the iliofemoral ligament limits extension at the hip joint
40) Regarding the popliteal fossa, which of the following statements is true?
a) the common peroneal nerve slopes downwards lateral to the biceps tendon
b) the sural nerve is a cutaneous branch of the common peroneal nerve
c) the middle genicular artery of the popliteal artery supply the cruciate ligaments
d) the popliteus muscle is supplied by a branch of the common peroneal nerve
e) the recurrent genicular nerve is a branch of the tibial nerve

41) Regarding the extensor compartment of the lower leg, all of the following statements are true EXCEPT:
a) the tibialis anterior muscle is supplied by the deep peroneal and recurrent genicular nerves (L4)
b) extensor digitorum longus and peroneus tertius muscle lie lateral to tibialis anterior artery throughout
c) the deep peroneal nerve arises within the peroneus longus muscle
d) the extensor digitorum longus dorsiflex the lateral toes
e) the extensor hallucis longus arises from the middle two-fourths of the tibia and the adjacent
interosseous membrane

42) Regarding the foot, all of the following statements are true EXCEPT:
a) the tibialis posterior muscle inverts and adducts the forefoot
b) the tibialis posterior muscle plantarflex the ankle joint
c) the tibialis anterior muscle dorsiflex the ankle and inverts the foot
d) all interossei muscles are supplied by the lateral plantar nerve
e) calcaneal branches of the deep peroneal nerve supply the skin of the heel

43) The popliteal artery:


a) is superficial to the tibial nerve
b) extends from the hiatus in adductor longus
c) enters the popliteal fossa on lateral aspect of the femur
d) has four genicular branches in fossa
e) supplies the cruciate ligaments

44) The obturator nerve:


a) adductor magnus
b) obturator internus
c) quadratus femoris
d) sartorius
e) inferior gemellus

45) Which of the following is correctly paired?


a) adductor brevis – femoral nerve
b) adductor longus – sciatic nerve
c) adductor magnus – saphenous nerve
d) adductor longus – obturator nerve
e) adductor magnus – femoral nerve

46) The anterior cruciate ligament::


a) lies within the synovial membrane of the knee joint
b) attaches from the anterior tibial plateau to the medial condyle of the femur
c) prevents forward displacement of the femur on the tibial plateau
d) produces lateral rotation of the femur in the ‘screw home’ position of full extension
e) none of the above
47) The surface marking for the femoral nerve is:
a) midway between the A.S.I.S. and pubic tubercle
b) midway between the A.S.I.S. and pubic synthesis
c) medial to the femoral artery
d) 2cm lateral and 2cm interior to the pubic tubercle
e) none of the above

48) In the popliteal fossa, the deepest of these structures is:


a) popliteal vein
b) popliteal artery
c) tibial nerve
d) sural nerve
e) plantaris muscle

49) Which of the following bursae is most likely to communicate with the knee joint?
a) deep infrapatellar bursa
b) superficial infrapatellar bursa
c) prepatellar bursa
d) semimembranosis bursa
e) suprapatellar bursa

50) Adductor longus is inserted onto the:


a) upper half of the linea aspera of the femur
b) upper two thirds of the linea aspera of the femur
c) upper one third of the linea aspera of the femur
d) lower two thirds of the linea aspera of the femur
e) lower half of the linea aspera of the femur

51) The muscle which provides the most control of hip joint movement during the act of sitting is:
a) iliacus
b) semitendinosis
c) semimembranosis
d) gluteus maximus
e) gluteus medius

52) Structures passing through the greater sciatic foramen include all of the following EXCEPT:
a) tendon of obturator internus
b) piriformis muscle
c) posterior cutaneous nerve of the thigh
d) pudendal nerve
e) nerve to quadratus femoris

53) The medial compartment of the thigh:


a) contains obturator internus
b) contains the adductor canal
c) contains the femoral triangle
d) is limited superiorly by the obturator membrane
e) is supplied mainly by the obturator artery
54) The strongest fibres of the ‘deltoid’ ligament in the ankle run from the tibial malleolus to:
a) medial tubercle of the talus
b) the neck of the talus
c) the sustenaculum tali
d) the navicular bone
e) the medial cuneiform
Section 2

Lower Limb – Answers

1 C 28 C
2 A 29 B
3 A 30 E
4 A 31 A
5 B 32 B
6 C 33 D
7 D 34 D
8 E 35 A
9 C 36 E
10 E 37 C
11 D 38 B
12 A 39 C
13 B 40 C
14 D 41 E
15 A 42 E
16 B 43 E
17 C 44 A
18 D 45 D
19 C 46 E
20 D 47 A
21 C 48 B
22 C 49 E
23 D 50 D
24 E 51 D
25 A 52 A
26 B 53 D
27 E 54 C
Section 3

1) In the femoral triangle:


a) the femoral nerve emerges from the femoral sheath
b) the saphenous nerve lies medial to the femoral artery at the apex
c) the genitofemoral nerve pierces the anterior surface of the femoral sheath
d) the profunda femoris artery arises from the medial aspect of the femoral artery
e) the obturator nerve passes anterior to pectineus

2) The iliotibial tract is the conjoined aponeurosis of the tensor fasciae lata and:
a) gluteus minimus
b) gluteus medius
c) gluteus maximus
d) Camper’s fascia
e) Scarpa’s fascia

3) Fourth lumbar nerve root supplies:


a) hip flexors
b) tibialis anterior
c) skin on the big toe
d) flexor longus digitorum
e) flexor accessories (quadratus plantae)

4) The base of Scarpa’s femoral triangle is formed by:


a) sartorius
b) adductor longus
c) inguinal ligament
d) pubic tubercle
e) none of the above

5) Passing through the greater sciatic notch deep to the sciatic nerve is which of the following?
a) internal pudendal vessels and nerve
b) inferior gemellus muscle
c) posterior cutaneous nerve of the thigh
d) nerve to quadratus femoris
e) none of the above

6) The femoral vein lies …….. to the femoral artery in the femoral sheath:
a) lateral
b) medial
c) anterior
d) posterior
e) femoral vein is not in the femoral sheath
7) The main function of gluteus maximus is which of the following:
a) a site for injections
b) a cushion for sitting
c) a flexor of the hip
d) a lateral rotator of the hip
e) none of the above

8) Tensor fascia latae:


a) is quadrangular in shape
b) is supplied by the femoral nerve
c) extends the hip
d) is an atavistic remnant of the panniculus carnosus muscle
e) lies edge to edge with sartorius at the anterior superior iliac spine

9) The superior gluteal nerve supplies:


a) gluteus medius
b) gluteus minimus
c) tensor fascia latae
d) none of the above
e) all of the above

10) The hamstring muscles originate from:


a) body of the ischium
b) ramus of the pubis
c) iliac crest
d) ischial tuberosity
e) symphysis pubis

11) The upper tibial epiphysis appears at:


a) birth
b) 1 year
c) 2 year
d) 3 years
e) puberty

12) At birth:
a) all the tarsal bones are ossified
b) only calcaneus is ossified
c) calcaneus and talus are ossified
d) calcaneus, talus and cuboid are ossified
e) none of the above

13) Which of the following is found in the popliteal fossa?


a) sciatic nerve
b) femoral vein
c) common peroneal nerve
d) femoral artery
e) saphenous nerve
14) The short saphenous vein passes below and behind the:
a) medial malleolus
b) lateral malleolus
c) medial epicondyle
d) lateral epicondyle
e) greater trochanter

15) When standing, the knee joint is locked in extension by:


a) lateral rotation of the tibia
b) medial rotation of the femur
c) tightening of the medial ligament
d) tightening of the lateral ligament
e) tension in the oblique popliteal ligament

16) The posterior cutaneous nerve of the thigh:


a) consists only of S2, 3
b) travels most of its course superficial to the fascia lata
c) innervates a small area on the labia majora
d) emerges above pinforris
e) none of the above

17) The deep peroneal nerve supplies:


a) skin between the first and second toes
b) skin between the second and third toes
c) skin on the medial side of the shin
d) skin on the dorsolateral side of the foot
e) the great toe only

18) Attached to lateral meniscus is which of the following:


a) posterior cruciate ligament
b) lateral ligament of the knee
c) mucous fold
d) popliteus muscle
e) oblique popliteal ligament

19) The obturator nerve is derived from the anterior rami of:
a) T12, L1 and L2
b) L1, L2 and L3
c) L2, L3 and L4
d) L3, L4 and S1
e) none of the above

20) The skin crease of the hip:


a) is where the inguinal ligament is attached to the fascia lata
b) is where the external oblique aponeurosis is joined to Scarpa’s fascia
c) is where Scarpa’s fascia is attached to the fascia lata
d) is mainly supplied by the femoral nerve
e) none of the above
21) Peroneus tertius:
a) acts only to evert the foot
b) arises from the lower anterior part of the tibia
c) may insert into the neck of the fifth metatarsal
d) passes superficial to the extensor retinaculum
e) is innervated by the superficial peroneal nerve

22) Structures closely related to long saphenous vein at ankle include which of the following?
a) major perforating veins to deep venous system
b) a branch of the femoral nerve
c) medial superficial lymphatic trunks
d) a branch of the anterior tibial nerve
e) dorsalis pedis artery

23) The only muscle to cross the anterior tibial artery is:
a) extensor hallucis longus
b) extensor digitorum brevis
c) extensor hallucis brevis
d) extensor digitorum longus
e) tibialis anterior

24) The dorsalis pedis artery is:


a) lateral to extensor hallucis longus at the ankle
b) medial to extensor hallucis longus at the ankle
c) medial to tibialis anterior at the ankle
d) found perforating the first metatarsal space and joining with the medial plantar artery
e) lateral to the digital branch of the deep peroneal nerve

25) Features of the fibula include which of the following?


a) it is on the medial side of the tibia
b) its medial surface is grooved for the origin of tibialis posterior
c) it is ossified from five centres
d) it does not provide origin for flexor digitorum longus
e) its lower third is rough for the origin of soleus

26) Which of the following is true of the saphenous nerve?


a) is predominantly from L2
b) supplies adductor magnus
c) pierces the deep fascia in the femoral triangle
d) is cutaneous only
e) terminates just below the knee

27) The superficial epigastric, superior perforating and deep external pudendal arteries are all branches of:
a) profunda femoris
b) popliteal
c) internal iliac
d) external iliac
e) none of the above
28) Which of the following is NOT a branch of the profunda femoris artery?
a) medial femoral circumflex
b) lateral femoral circumflex
c) popliteal
d) perforating
e) all are branches of the profunda

29) The long saphenous vein:


a) passes anterior to the inguinal ligament
b) passes posteriorly to the medial malleolus
c) ascends the lateral side of the leg
d) receives tributaries from the perineum
e) is in close relation with the saphenous nerve throughout the length of its course

30) The chief dorsiflexor of the ankle joint:


a) peroneus tertius
b) tibialis anterior
c) extensor longus hallucis
d) extensor longus digitorum
e) none of the above

31) Iliopsoas:
a) supplied by obturator nerve
b) medial rotator of hip
c) synergist of quadriceps femoris
d) lateral rotator of hip
e) none of the above

32) The lumbar plexus is formed by ventral primary rami of:


a) T12, L1, L2 and L3
b) L1, L2, L3 and L4
c) L2, L3, L4 and L5
d) L2, L4, L5 and S1
e) formed by dorsal primary rami

33) The cutaneous nerve supplying the medial aspect of the calf is:
a) anterior femoral cutaneous
b) sural
c) superficial peroneal
d) saphenous
e) posterior femoral cutaneous

34) The nerve supply to the knee joint comes from:


a) sciatic
b) femoral
c) obturator
d) all of these
e) none of these
35) The most powerful extensor of the hip is:
a) gluteus maximus
b) psoas major
c) iliacus
d) obturator externus
e) piriformis

36) Which of the following is not an action of gracilis?


a) adduction of thigh
b) flexion of knee
c) extension of thigh
d) medial rotation of the flexed knee
e) none of these

37) Obturator externus:


a) is pierced by femoral circumflex artery
b) external rotator of hip
c) internal rotator of hip
d) hip flexor
e) supplied by S.I.

38) The intermediate cutaneous nerve of the thigh:


a) arises from the sacral plexus
b) is a branch of the obturator nerve
c) pierces sartorius
d) extends beneath the knee
e) arises independently of the medial cutaneous nerve of the thigh

39) The dorsalis pedis artery is a continuation of:


a) anterior perforating branch of posterior tibial
b) anterior tibial
c) popliteal
d) femoral
e) peroneal

40) The lateral aspect of the thigh has a cutaneous nerve supply derived from:
a) L2 and 3
b) L3 and 4
c) L5, S1 and S2
d) L4, L5 and S1
e) S1 and S2

41) The sole of the foot has a cutaneous nerve supply derived from:
a) L4, L5, S1 and S2
b) L5 and S1
c) L4, L5 and S1
d) L4 and L5
e) L5, S1 and S2
42) The adductor (subsartorial) cancal of Hunter is bounded laterally by:
a) adductor longus
b) adductor magnus
c) vastus medialis
d) sartorius
e) femoral vein

43) In the upper part of the popliteal fossa the following are found from medial to lateral:
a) popliteal artery, popliteal vein, sciatic vein
b) popliteal vein, popliteal artery, sciatic nerve
c) sciatic nerve, popliteal artery, popliteal vein
d) sciatic nerve, popliteal vein, popliteal artery
e) popliteal artery, sciatic nerve, popliteal vein

44) Flexor digitorum longus:


a) lies superficial to tibialis posterior
b) muscle belly lies medial to flexor hallucis longus
c) arises from both tibia and fibula
d) has communications with flexor longus hallucis
e) all of the above

45) Posterior tibial artery:


a) arises at the upper border of popliteus
b) has no accompanying sympathetic nerve plexus
c) lies posterior to flexor longus digitorum under flexor retinaculum
d) lies on peroneus brevis for part of its course
e) all of the above

46) Flexor longus digitorum:


a) crosses deep to tibialis posterior in calf
b) crosses superficial to flexor longus hallucis in sole
c) is an evertor of the foot
d) supplied by musculocutaneous nerve
e) supplied by L5 nerve root

47) The long saphenous vein:


a) lies deep to the deep fascia only near its termination
b) normally drains blood from deep veins
c) communicates with the deep venous system only indirectly
d) normally receives blood from the deep venous system
e) has no valves other than at saphenofemoral junction

48) Concerning the talus:


a) blood supply to body enters only through the dorsum of the neck
b) superior articular facet is broader posteriorly than anteriorly
c) articulates with cuboid
d) has no muscles attached
e) all of the above
49) Concerning the ankle:
a) movements of dorsi and plantar flexion only are possible
b) communicates with inferior tibiofibular joint
c) communicates with posterior subtalar joint
d) dorsiflexion accompanied by some eversion
e) can be plantarflexed by flexor longus hallucis

50) At the ankle, the posterior tibial nerve:


a) has no further motor branches
b) has no further cutaneous branches
c) lies anterior to the artery
d) lies anterior to flexor longus hallucis
e) none of the above

51) Biceps femoris:


a) inserts partially into the tibial condyle
b) has intramuscular tendon
c) attached proximally to the ilium
d) supplied by L4
e) shares its origin with semimembranosis

52) Common peroneal nerve:


a) supplies the knee joint
b) supplies semitendinosus
c) supplies skin on sole
d) all of the above
e) none of the above

53) On the front of the ankle joint, the tendon of extensor hallucis longus:
a) is medial to tibialis anterior
b) is medial to deep peroneal nerve
c) is lateral to extensor digitorum longus
d) possesses no synovial sheath
e) is lateral to extensor hallucis brevis

54) Iliofemoral ligament:


a) limits hip flexion
b) limits hip extension
c) limits hip adduction
d) limits hip internal rotation
e) none of the above

55) At the upper end of the femur:


a) gluteus maximus is attached to a ridge on the posterior surface
b) gluteus medius is attached to the anterior surface of the greater trochanter
c) the three secondary centres of ossification fuse together before joining the shaft
d) the posterior part of the capsular ligament is attached to the intertrochanteric crest
e) main nutrient artery enters the bone
56) Medial longitudinal plantar arch:
a) raised by peroneus longus
b) maintained by ligamentum bifurcation
c) maintained by talocalcaneal interosseous ligament
d) all of the above
e) none of the above

57) The femoral nerve:


a) continues as a cutaneous branch which runs along the lateral border of the foot
b) supplies iliacus muscle
c) supplies psoas muscle
d) supplies obturator externus muscle
e) lies within the femoral sheath

58) Rectus femoris muscle:


a) occupies an intermediate plane in the quadriceps muscle mass
b) arises from the anterior superior iliac spine
c) has two heads of origin
d) supplied by ilioinguinal nerve
e) none of the above

59) The deep fascia of the thigh:


a) is attached to the inguinal ligament
b) is mostly superficial to the long saphenous vein
c) receives the insertion of the whole of the gluteus maximus
d) receives the insertion of the whole of sartorius
e) is less dense than the deep fascia of the upper arm

60) Biceps femoris muscles:


a) has a common origin with semitendinosus from the ischial tuberosity
b) has a short head attached to the femur medial to the attachment of adductor magnus
c) is entirely innervated by common peroneal nerve
d) is deep to the common peroneal nerve
e) is a lateral rotator of the leg on the thigh when the leg is fully extended at the knee joint

61) The pudendal nerve:


a) leaves the pelvis through the lesser sciatic foramen
b) enters the perineum lateral to the nerve to the obturator internus muscle
c) runs in the roof of the ischiorectal fossa
d) is sensory to the skin of the scrotum
e) innervates the internal rectal sphincter

62) The sciatic nerve in the gluteal region:


a) rests directly on ischium
b) is accompanied by posterior cutaneous nerve of thigh
c) supplies obturator internus
d) supplies quadratus femoris
e) none of the above
63) Short saphenous vein:
a) perforates the deep fascia in the midcalf
b) medial to the tendoachilles
c) more valves than the long saphenous
d) none of the above
e) all of the above

64) Pectineus:
a) medial rotator of hip
b) sometimes supplied by obturator nerve
c) flexor of hip
d) all of the above
e) none of the above

65) The segmental supply to the posterior cutaneous nerve of the thigh is:
a) S3, 4
b) L4, 5
c) S1, 2, 3
d) L4, 5 and S1
e) none of the above

66) Long saphenous vein:


a) is deep to the deep fascia for most of its course
b) drains the medial side of the leg between tibia and tendocalcaneous
c) arises in the femoral triangle
d) the superficial circumflex iliac vein is a tributary
e) none of the above

67) Attached to proximal tibial epiphysis:


a) the whole of the medial collateral ligament of the knee
b) sartorius
c) ligamentum patellae
d) popliteus
e) semitendinosus

68) Emerging from lesser sciatic foramen:


a) piriformis
b) superior gemellus
c) obturator internus
d) inferior gemellus
e) obturator externus

69) If the common peroneal nerve is divided the following are lost:
a) plantar flexion of toes
b) inversion of foot
c) dorsiflexion of foot
d) plantar flexion of foot
e) there is no loss of cutaneous sensation
70) Flexor hallucis longus muscle:
a) is attached to the tibia
b) has a tendon which in the sole, is superficial to that of flexor longus digitorum
c) is a unipennate muscle
d) is attached to the proximal phalanx of the great toe
e) none of the above

71) Middle cuneiform:


a) articulates with talus
b) articulates with the third metatarsal
c) receives portion of insertion of tibialis anterior
d) gives attachment to short plantar ligament
e) none of the above

72) Profunda femoris artery:


a) first branch from femoral artery
b) main arterial supply to leg
c) spirals down from lateral side of the femoral artery and runs behind the upper border of adductor
longus
d) lies between obturator externus and adductor magnus
e) none of the above

73) Talus:
a) receives all its blood supply to the body through dorsal aspect of neck
b) gives attachment to spring ligament
c) posterior aspect of body grooved by flexor longus hallucis
d) gives partial origin to abductor hallucis
e) none of the above
Section 3

Answers

1 C 38 C
2 C 39 B
3 B 40 A
4 C 41 B
5 D 42 C
6 B 43 A
7 E 44 E
8 E 45 C
9 E 46 B
10 D 47 A
11 A 48 D
12 D 49 E
13 C 50 D
14 B 51 A
15 B 52 A
16 C 53 B
17 A 54 B
18 D 55 A
19 C 56 E
20 C 57 B
21 C 58 C
22 B 59 A
23 A 60 A
24 A 61 D
25 B 62 A
26 D 63 D
27 E 64 D
28 C 65 C
29 D 66 D
30 B 67 C
31 B 68 C
32 B 69 C
33 D 70 E
34 D 71 E
35 A 72 C
36 C 73 C
37 B
Section 4

1) Gluteus maximus:
a) superficial muscle of buttock ch???? by small fibre size
b) 90% of muscle inserts into upper end of iliotibial tract
c) four bursa lie beneath to muscle
d) shared common nerve supply with gluteus medius
e) blood supply from both superior and inferior gluteal artery

2) Piriformis is the key to gluteal region. Which relation is not TRUE?


a) in buttock, lower border lie alongside superior gemellus
b) converges to ??? tendon and inserts on upper boarder of greater trochanter
c) emerges through greater sciatic foramen with superior gluteal nerve and vessel above it
d) emerges through the greater sciatic foramen with pudendal nerve and vessels deep to it
e) emerges through greater sciatic foramen with sciatic nerve on its surface

3) Of the hip joint ligaments and capsule:


a) capsule attaches circumferentially to neck of???? anterior trochanteric line
b) retinacular fibres of capsule bind down nutrient ????? from cruciate anaster?????
c) iliofemoral ligament becomes taut on medial rotation and extension
d) all three ligaments attach to capsule and completely enclose joint
e) psoas major tendon separates capsule from femoral nerve

4) Superficial cutaneous nerves supplying the thigh include the following EXCEPT:
a) ilioinguinal nerve
b) saphenous nerve
c) femoral branch of genitofemoral nerve
d) medial femoral cutaneous nerve
e) intermediate femoral cutaneous nerve

5) The flexor compartment of the thigh contains which of the following muscles?
a) gluteus maximus
b) adductor magnus
c) garacilis
d) semimembranosus
e) rectus femoris

6) Which of the following is true of the great saphenous vein?


a) it passes posterior to the medial malleolus
b) it runs behind the lateral border of the tibia
c) it passes through the ???cribriform fascia covering the saphenous opening below the inguinal
ligament
d) it joins the femoral vein from the anterolateral side
e) it has no tributaries
7) Which is not an origin of vastus lateralis?
a) upper half of the intertrochanteric line
b) aponeurosis of tensor fascia lata
c) lateral lip of the linea aspera
d) upper two thirds of the lateral supracondylar line of femur
e) lateral intermuscular septum

8) Regarding the adductor canal:


a) it contains the nerve to vastus intermedialis
b) contents leave by piercing adductor longus
c) the femoral artery is always between the saphenous nerve and femoral vein in the thigh
d) below the adductor hiatus, the canal is occupied by the saphenous nerve of the descending
genicular nerve
e) at the adductor hiatus, the femoral vein is medial to the artery

9) At the hip:
a) the ligament of the head of the femur is attached to the acetabular notch
b) the pubofemoral ligament is the weakest ligament at the hip
c) flexion tightens the ligaments
d) the obturator nerve via its anterior division, innervates the capsule and retinacular fibres
e) the normal range of flexion is 160°

10) Regarding the cuneiform bones:


a) the lateral is the smallest
b) tibialis anterior is inserted into a facet on the intermediate cuneiform
c) flexor hallucis brevis has an origin on the medial cuneiform
d) the anterior surface of the medial cuneiform is triangular in shape
e) the second metatarsal bone articulates with all three cuneiforms

11) Regarding the dorsum of the foot:


a) cutaneous innervation is primarily from the sural nerve
b) extensor digitorum brevis gives off four tendons to the lateral four toes
c) the superficial peroneal nerve divides into medial and lateral branches below the ankle
d) the inferior extensor retinaculum joins medial and lateral malleoli
e) dorsalis pedis artery runs to the base of the first intermetatarsal space

12) Regarding the sole of the foot:


a) the heel is supplied by lateral calcanean nerves
b) flexor hallucis brevis lies in the first muscular layer
c) flexor digitorum brevis is the lower limb equivalent of flexor digitorum superficialis
d) the plantar arteries and nerves lie between the second and third muscular layers
e) the medial plantar artery forms the plantar arch with dorsalis pedis artery

13) At the ankle joint:


a) the distal fibular is not part of the joint
b) the medial ligament is made up of three separate bands
c) the posterior tibiofibular ligament is also known as posterior transverse ligament
d) the long and short peronei muscles assist in plantar flexion
e) nerve supply is from the anterior and posterior tibial nerves
14) Which is NOT true about fractured neck of femurs?
a) the leg is shortened and externally rotated in most fractured neck of femurs
b) the main source of blood to the femoral head is via the vessels running within cancellous bone
from the diaphysis
c) a subcapital fracture cuts off all the blood to the head of the femur resulting in avascular necrosis
d) the blood supply to the head is increased by vessels in the capsular retinacula and it is this which
prevents avascular necrosis of the head after an intertrochanteric fracture
e) the ligamentum teres attaches to the central fovea???? on the femoral head and originates from the
acetabulum

15) Trendelenburg’s test is negative if:


a) the hip adductors are paralysed (eg in poliomyelitis)
b) there is an old unreduced or congenital dislocation of the hip
c) there is an ununited fracture of the neck of femur
d) the patient walks with a dipping gait
e) gluteus minimus and medius and tensor fascia latae are weakened severely

16) Which of the following structures can be missing in a completely stable and functional knee?
a) ACL
b) PCL
c) oblique ligament
d) patella
e) lateral collateral ligament

17) Which statement about femoral hernias is INCORRECT?


a) it is commoner in males than females
b) it is never due to a congenital sac
c) the femoral cord acts as a lymphatic pathway from the lower limb to the external iliac nodes
d) the neck of a femoral hernia can be distinguished from an inguinal hernia because it lies below and
lateral to the pubic tubercle
e) the femoral cord normally contains a fat plug and cloquet’s gland but can also accommodate a
distended femoral vein

18) In the sole:


a) plantar arteries and nerves lie between second and third layers
b) the myotome is essentially S1
c) the medial plantar nerve supplies the medial 4½ toes
d) tendons for peroneus longus and tibialis posterior lie in the third layer
e) abductor digiti minimi is in the first layer

19) Which is supplied by the medial plantar nerve?


a) adductor hallucis
b) abductor digiti minimi
c) flexor hallucis longus
d) flexor accessories
e) first lumbrical
20) At the ankle:
a) the capsule is attached to the posterior tibiofibular ligament
b) the deltoid ligament has three parts
c) the joint is a simple hinge joint
d) the joint undergoes dorsiflexion, plantar flexion, inversion and eversion
e) nerve supply is deep and superficial peroneal nerves and tibial nerves

21) The cruciate anastomosis is NOT joined by:


a) transverse branch of the lateral circumflex A
b) descending branch of the internal pudendal A
c) ascending branch of the first perforating A
d) descending branch of the inferior gluteal A
e) transverse branch of the medial circumflex

22) Stability of the patella in knee extension is maintained primarily by:


a) inferior fibres of vastus lateralis
b) relative prominence of the medial femoral condyle
c) inferior fibres of vastus medialis
d) tension of medial patella retinaculum
e) articularis genu muscle

23) Regarding the branches of the femoral nerve:


a) does NOT supply cutaneous sensation to skin over the femoral triangle
b) femoral cutaneous nerves pass through the fascia lata via the saphenous canal
c) saphenous nerve follows the course of the great saphenous vein
d) branch to pectineus passes between the femoral artery and vein
e) generally branch within the femoral sheath

24) Profunda femoris artery is separated from the femoral artery by:
a) pectineus
b) satorius
c) fascia lata
d) femur
e) adductor longus

25) Femoral canal contains:


a) femoral nerve
b) lymph node (of cloquet)
c) femoral artery
d) femoral vein
e) B, C and D are correct

26) Regarding the saphenous opening:


a) transmits the contents of the femoral sheath
b) posterior wall lies immediately anterior to pectineus
c) the great saphenous vein passes superiomedially through it
d) bounded medially by the lacunar ligament
e) the falciform edge attaches superiorly to the pectineal line
27) Piriformis:
a) is an abductor of the hip in hip flexion
b) passes through the lesser sciatic foramen
c) is the preferred site of intramuscular gluteal injection
d) passes anterior to the femoral neck
e) lies deep to the sciatic nerve

28) Popliteus:
a) attaches to the medial femoral condyle
b) “locks” the knee in extension
c) supplied by a branch of the femoral nerve
d) lies immediately deep to the popliteal artery
e) may attach to the medial meniscus

29) The third layers of muscles of the sole of the foot include:
a) four lumbricals and quadratus plantae
b) plantar and dorsal interossei
c) extensor hallucis longus and extensor digitorum longus
d) flexor digiti minimi brevis, adductor hallucis tranversus, adductor hallucis obliquus and flexor
hallucis brevis
e) abductor hallucis, abductor digiti minimi and flexor digitorum brevis

30) Peroneus longus inserts into:


a) medial cuneiform and first metatarsal
b) base of 5th metatarsals
c) 4th and 5th metatarsal
d) navicular tuberosity
e) cuboid tuberosity

31) The transverse arch of the foot is formed by:


a) calcaneus, talus, navicular, cuneiforms and first three metatarsals
b) navicular, cuneiforms, cuboid, all five metatarsals
c) calcaneus, cuboid, lateral two metatarsals
d) calcaneus, navicular, lateral two metatarsals
e) sustentaculum tali and cuneiforms

32) Which of the following is TRUE?


a) the popliteal fossa is bounded by the biceps medially
b) the great saphenous vein runs through the popliteal fossa
c) gluteus maximus inserts on the greater trochanter
d) the sciatic nerve leaves the pelvis by passing through the lesser sciatic foramen
e) the popliteal fossa contains the common peroneal nerve
33) The femoral triangle:
a) the femoral triangle is bounded by the inguinal ligament medial border of sartorius and lateral
border of adductor longus
b) the mid-inguinal joint is midway between the pubic tubercle and the anterior superior iliac spine
c) the femoral canal contains the lymph node of cloquet
d) the femoral sheath contains the femoral nerve and femoral artery
e) the femoral and profunda femoris arteries are separated by adductor brevis

34) The knee:


a) the cruciate ligaments are intra-synovial
b) the posterior cruciate ligament stabilises the flexed weight-bearing knee
c) the posterior horn of the medial meniscus is attached to the intercondylar area of the tibia behind
the posterior cruciate ligament
d) the knee joint normally contains 5.0ml of synovial fluid
e) active rotation may occur in the extended knee

35) Which one of the following muscles has a double nerve supply?
a) rectus femoris
b) sartorius
c) pectineus
d) adductor longus

36) Inversion and eversion of the foot take place MAINLY at the:
a) ankle joint
b) joints between the talus and calcaneus
c) joint between calcaneus and navicular bone
d) calcanocuboid joint
e) inferior tibiofibular joint

37) Which one of the following has a tendo that is intracapsular?


a) plantaris
b) popliteas
c) rectus femoris
d) psoas major
e) peroneal longus

38) The deltoid ligament belongs to the:


a) ankle joint
b) hip joint
c) knee joint
d) talocalcaneonavicular joint
e) calcaneocuboid joint
Section 4

Answers

1 E
2 D
3 C
4 B
5 D
6 C
7 B
8 C
9 D
10 E
11 E
12 C
13 D
14 C
15 A
16 D
17 A
18 E
19 E
20 A
21 B
22 C
23 A
24 E
25 B
26 B
27 A
28 D
29 no answer
30 no answer
31 no answer
32 no answer
33 C
34 B
35 C
36 B
37 A
38 A
1 Regarding superficial nerves of the anterior thigh
A The ilioinguinal nerve only supplies external genitalia
B The genitofemoral nerve supplies the skin over the femoral triangle
C The medial femoral cutaneous nerve arises from L3/4
D The intermediate femoral cutaneous nerve supplies a small area of skin over the inguinal ligament
E The lateral femoral cutaneous nerve runs lateral to the anterior superior iliac spine

2 The great saphenous vein


A arises on the lateral aspect of the foot
B can be found 2cm medial to the patella
C pierces the fascia lata on the lateral side of the thigh
D receives no tributaries above the knee
E contains approximately 20 valves

3 Regarding the femoral triangle


A The lateral border is formed by the lateral border of sartorius
B The medial border is the medial border of adductor magnus
C The femoral nerve is contained in the femoral sheath
D The lymph node of cloquet lies in the femoral canal
E The femoral vein is lateral to the artery

4 Regarding the femoral artery, all of the following are true EXCEPT
A The artery enters the femoral triangle at the mid-inguinal point
B Passes anterior to the profunda femoris branch
C Supplies muscles of the adductor compartment
D Ceases at the mid point of the popliteal fossa
E Lies medial to the femoral nerve

5 Regarding the femoral nerve, all of the following are true EXCEPT
A It is formed from the anterior divisions of the anterior rami of L2/3/4
B It supplies the muscles of the anterior compartment
C It does not lie within the femoral sheath
D It supplies iliacus but not psoas
E Branches include the medial and intermediate femoral cutaneous nerves

6 Regarding the obturator nerve, all of the following are true EXCEPT
A It is formed from the anterior divisions of the anterior rami of L2/3/4
B Its anterior division supplies adductor longus, brevis, pectineus and gracilis
C Its posterior division supplies all of adductor magnus
D It gives a cutaneous branch which supplies the medial thigh
E It gives articular branches to the hip and knee joints

7 Gluteus maximus
A Arises from the gluteal fossa of the ileum between the middle and superior gluteal lines
B is supplied by the superior gluteal nerve
C extends and medially rotates the hip
D mostly inserts into the iliotibial tract
E paralysis results in a waddling gait
8 The pudendal nerve
A Arises from L5/S1/2
B Emerges from the upper border of piriformis
C Contains only sensory fibres
D Passes medial to the ischial spine
E Passes through the greater sciatic foramen to enter the pelvis

9 Regarding the hamstring muscles, all of the following are true EXCEPT
A All of the hamstrings arise from the innominate bone
B All of the hamstring muscles are supplied by the tibial part of the sciatic nerve
C The long head of biceps femoris and semitendinosus have a common origin
D The adductor magnus is not part of the hamstring group
E Biceps forms the medial border of the popliteal fossa

10 The sciatic nerve


A Arises from L3/4/5/S1/2
B Emerges from the lower border of piriformis
C Most commonly divides onto common peroneal and tibial branches in the middle of the hamstring
compartment
D Can be injured by intramuscular injections in the upper outer quadrant of the buttock
E Gives no branches in the gluteal compartment

11 All of the following are lateral rotators of the hip EXCEPT


A Gluteus maximus
B Gluteus medius
C Gamellus superior
D Quadratus femoris
E Piriformis

12 Ligamentous stability for the hip joint is provided chiefly by the


A Ligamentum teres
B Ischiofemoral ligament
C Pubofemoral ligament
D Iliofemoral ligament
E Transverse ligament

13 Contents of the popliteal fossa include all of the following EXCEPT


A Sural nerve
B Superior medial genicular artery
C Sural communicating nerve
D Inferior medial genicular artery
E Anterior tibial artery

14 Regarding ligaments of the knee joint


A The anterior cruciate ligament inserts into the posteromedial aspect of the lateral femoral condyle
B The arcuate ligament is an expansion of the tendon of semimembranosus
C The meniscofemoral ligaments cross in front and behind the anterior cruciate
D The medial collateral ligament is a cord-like structure
E The transverse ligament connects the posterior aspects of the menisci
15 Regarding the menisci of the knee
A They are attached to the femoral condyles
B They have a rich blood supply
C The medial meniscus is firmly attached to the capsule of the joint
D The medial meniscus gives origin to the meniscofemoral ligaments
E They are composed of mainly elastic fibres Anatomy – lower limb

16 Regarding movements of the knee joint


A Sartorius assists with flexion
B The only action of popliteus is unlocking of the knee
C Extension occurs to zero degrees
D Locking of the knee is an active process
E Rotation takes place above the menisci

17 Regarding the extensor compartment of the leg


A Tibialis anterior arises from the upper two thirds of the tibia and fibula
B Extensor digitorum longus has a small origin from the lateral condyle of the tibia
C Extensor hallucis longus is superficial to extensor digitorum longus
D All muscles are supplied by the common peroneal nerve
E Peroneus tertius and tibialis anterior both cause eversion of the foot

18 Which of the following structures does not pass anterior to the medial malleolus
A Tibialis anterior
B Extensor hallucis longus
C Flexor hallucis longus
D Anterior tibial artery
E Peroneus tertius

Q A
1 B
2 E
3 D
4 D
5 A
6 C
7 D
8 D
9 E
10 B
11 B
12 D
13 E
14 A
15 C
16 A
17 B
18 C
Hip and thigh

1. Femoral nerve
a. is less subject to damage by penetrating injuries of the lower abdomen than of the lower limb
b. Damage may cause anaesthesia of the foot
c. Is contained within the femoral sheath
d. Is formed by the anterior divisions of L2,3,4
e. Gives a single muscular branch to iliacus

2. With respect to the hip joint


a. The fibrous capsule is strengthened by 2 ligaments
b. Anteriorly the psoas major tendon separates the capsule from the femoral vein
c. It is least stable when flexed and adducted
d. Ligament of Bigelow is the weakest ligament
e. Ischiofemoral ligament is the strongest ligament

3. Femoral nerve
a. Is formed from the anterior divisions of the anterior primary rami of L2-4
b. Is formed from the same spinal segments as the obturator nerve
c. Divides after passing through the femoral triangle
d. Has no cutaneous branches other than the saphenous nerve
e. Enters the thigh in the femoral sheath

4. Which of the following does not pass through the greater sciatic foramen
a. The sciatic nerve
b. The pudendal nerve and vessels
c. The posterior cutaneous nerve of the thigh
d. Inferior gluteal vessels and nerve
e. Nerve to obturator externus

5. Which of the following are not found in the adductor (subsartorial) canal
a. Femoral artery
b. Femoral vein
c. Femoral nerve
d. Saphenous nerve
e. Nerve to vastus medialis

6. A 30 y.o. man presents with adenopathy of the medial group of superficial inguinal lymph nodes on the
right side. Which of the following is the primary site resulting in this finding?
a. Right testis
b. Right buttock
c. Skin of lower limb
d. Anal canal
e. None of the above
7. Following a subcapital fracture of the neck of femur, an 80 y.o. man sustains avascular necrosis of the
femoral head. This is most likely to be the consequence of interruption to the blood supply to the head
from which of the following sources?
a. Arteries from the trochanteric anastomoses in the retinacula
b. Artery of the ligament of the head from the obturator artery
c. Branches from the profunda femoris artery
d. Branches from the pudendal artery
e. Branches from the inferior gluteal artery

8. The muscle which provides the most control of hip joint movement during the act of sitting is
a. Iliacus
b. Semitendonosis
c. Semimembranosis
d. Gluteus maximus
e. Gluteus minimis

9. Which of the following are correctly paired?


a. Adductor brevis – femoral nerve
b. Adductor longus – sciatic nerve
c. Adductor magnus – saphenous nerve
d. Adductor longus – obturator nerve
e. Adductor magnus – femoral nerve

10. The great saphenous vein


a. Is a continuation of the lateral marginal vein of the foot
b. Runs between the 2 heads of gastrocnemius
c. Pierces the cribriform fascia in the upper thigh
d. Can be found immediately below and lateral to the pubic tubercle
e. Does not communicate with varicosities in the superficial veins

11. With regard to the femoral triangle


a. It is bounded by adductor longus and magnus
b. It has the fascia lata lining it s floor
c. The femoral artery lies between the femoral vein and nerve
d. It is bounded superficially by the lacunar ligament
e. The femoral sheath contains only the femoral nerve and artery

12. the femoral artery


a. Is separated from the hip joint capsule by fat only
b. Is crossed by the femoral vein from medial to lateral as it descends
c. Is found at the mid-inguinal point
d. Gives off the medial circumflex femoral artery as its major branch

13. Gluteus maximus


a. Is the deepest of the gluteal muscles
b. Forms the skin crease of the gluteal fold
c. Is supplied by L5, S1
d. Medially rotates and extends the hip joint
e. All of the above
14. Regarding the lymphatic drainage of the lower limb
a. It is predominantly along the route of the small saphenous vein
b. Apart from a small area of skin over the heel it drains via the popliteal lymph nodes from below the knee
c. From the superficial inguinal lymph nodes it passes through the cribriform fascia to the deep inguinal
nodes
d. Deep lymphatics follow veins
e. None of the above

15. The femoral nerve


a. Has superficial branches, one of which supplies the hip joint
b. Supplies psoas major
c. Lies within the femoral sheath
d. Emerges from the medial side of psoas major
e. Is formed from the posterior divisions of the ventral rami of L2,3,4

16. Regarding the femoral vein


a. It receives the great saphenous vein on its anterolateral surface
b. It drains into the internal iliac vein
c. It lies lateral to the femoral artery within the femoral sheath
d. It has no valves
e. It enters the inferior part of the femoral triangle posterior to the femoral artery

17. Contents of the femoral triangle include all except


a. Genital branch of the genitofemoral nerve
b. Great saphenous vein
c. Pectineus
d. Profunda femoris artery
e. Anterior division of the obturator nerve

18. The adductor canal


a. Is bounded by adductor brevis
b. Lies behind sartorius
c. Contains the femoral nerve
d. Commences just below the inguinal ligament
e. Contains the femoral artery which lies inferolaterally to the femoral vein in the lower part

19. The obturator nerve


a. Emerges on the lateral border of psoas
b. Supplies obturator externus, adductor longus and the knee joint
c. Supplies obturator internus, adductor magnus abd the hip joint
d. Runs inferior to the obturator artery in the obturator canal
e. All of the above

20. The femoral nerve


a. Has an anterior division which supplies skin on the antero-medial surface of the thigh
b. Runs medial to the femoral artery at the level of the inguinal canal
c. Has the sural nerve as the terminal branch
d. Supplies the posterior half of adductor magnus
e. Supplies pectineus via its posterior division
21. With regard to the head of the femur
a. The arterial supply comes mainly from the inferior gluteal artery
b. The artery to the head assumes importance after age of 7 years
c. Psoas lies posterior to the hip joint
d. The anterior division of the obturator nerve gives partial supply to the hip joint
e. None of the above

22. Regarding the bony pelvis


a. The obturator groove is in the ischial bone
b. The greater sciatic foramen transmits the obturator internus
c. The pectineal line lies superior to the acetabulum
d. The inguinal ligament inserts medially into the iliopubic eminence
e. None of the above

23. The hip joint


a. Is directed slightly forward along the axis of the femoral neck
b. Is supplied by the femoral and obturator nerves only
c. Has an articular surface which does not reach the rim of the acetabulum
d. Bears weight mainly through the ischial bone
e. Has a capsule which is strengthened anteriorly by the ischiofemoral ligament

24. The femoral triangle


a. Has sartorius as its medial border
b. Contains the posterior division of the obturator nerve
c. Contains femoral nerve and vessels
d. Has the lateral border of adductor longus laterally
e. All of the above

25. The muscles supplied by the femoral nerve include all except
a. Sartorius
b. Iliacus
c. Psoas major
d. Pectineus
e. Rectus femoris

26. Concerning the origins of the quadriceps femoris


a. All 4 component muscles have an origin from the femur
b. Vastus lateralis arises from the femur above intertrochanteric line and acetabulum
c. Vastus medialis arises from femur and tendon of adductor longus
d. Rectus femoris arises from 3 heads
e. Vastus intermedius arises from shaft of femur and greater trochanter

27. The floor of the femoral triangle consists of all of the following except
a. Psoas
b. Iliacus
c. Pectineus
d. Adductor brevis
e. Adductor magnus
28. Concerning iliacus
a. It inserts into the greater trochanter of the femur
b. It occupies and is attached to the whole of the iliac fossa
c. Nerve supply is femoral nerve
d. It acts to flex and laterally rotate the hip
e. It has the femoral vein as its intermediate anterior relation

29. Psoas major


a. Has a proximal attachment to the bodies discs and transverse processes of lumbar vertebrae
b. Has the lumbar plexus embedded within it
c. Has the lumbar arterie sand veins running behind it
d. Inserts into the lesser trochanter
e. All of the above

30. Sartorius
a. Arises from the ilium below the ASIS
b. Is pierced by the lateral cutaneous nerve of the thigh
c. Inserts into the styloid of the fibula
d. Is supplied by the obturator nerve
e. Flexes and medially rotates the thigh

31. Following Hiltons law, which nerve does not supply the hip joint
a. Sciatic
b. Obturator
c. Inferior gluteal
d. Nerve to rectus femoris
e. Femoral

32. branches of femoral artery ???

33. Superficial inguinal lymph nodes drain all of the following except
a. Anterior thigh
b. Base of penis
c. Testis

34. What goes through the lesser sciatic foramen?


a. Piriformis
b. Pudendal nerve
c. Internal pudendal artery
d. Superior gluteal artery
e. Inferior gluteal artery

35. Adductor magnus is


a. A bipennate muscle
b. A component of the femoral triangle
c. Supplied by the femoral nerve
d. A composite muscle
e. Attached by point of origin to the pectineal line of the pubic bone
36. Regarding the femoral artery and its branches
a. Lies lateral to femoral sheath
b. Femoral artery has three branches
c. Profunda femoris artery lies anterior to the profunda vein
d. The 4 perforating arteries supply all thigh muscles
e. The profunda femoris artery supplies all anterior thigh muscles

37. Regarding the inguinal canal


a. It has a roof formed by lower edges of internal oblique and transversus muscles
b. The ilioinguinal nerve enters the canal through the deep ring
c. Its posterior wall is formed by the external oblique aponeurosis
d. Its conjoint tendon lies anterior to the superficial inguinal ring
e. The superior epigastric artery crosses the posterior wall medial to the deep inguinal ring

38. Which of the following muscles is not in the floor of the femoral triangle
a. Pectineus
b. Adductor longus
c. Sartorius
d. Psoas
e. Iliacus

39. Regarding movements of the hip joint


a. Stability is reduced by the presence of the long femoral neck
b. Medial rotation is achieved by obturator externus
c. Sartorius is a lateral rotator
d. Medial rotation is resisted by the iliotibial tract
e. Abduction is not usually required in normal walking

40. Pectineus
a. Arises from part of the obturator membrane
b. Is inserted into the greater trochanter
c. Lies posterior to the anterior division of the obturator nerve
d. Forms one wall of the femoral ring
e. Is a lateral rotator of the femur

41. The femoral nerve


a. Supplies the skin over the lateral thigh
b. Lies between the pectineus and psoas in the femoral triangle
c. Is formed by the posterior divisions of the anterior rami of lumbar nerves 2,3 and 4
d. Breaks into superficial and deep branches, separated by the medial circumflex femoral artery
e. Supplies the adductor muscles

42. The sciatic nerve


a. Lies on the ischial tuberosity
b. Lies on the obturator internus
c. Passes upper quadratus femoris
d. Emerges from above piriformis
e. Is comprised of L4, L5, S1, S2
43. The medial compartment of the thigh contains all of the following except
a. The obturator nerve
b. Obturator artery
c. Gracilis muscle
d. Obturator internus
e. Obturator externus

44. Adductor magnus


a. Is a composite muscle
b. Has a hamstring part arising from ischiopubic ramus
c. Has an adductor part arising from ischial tuberosity
d. Has a tendinous attachment only onto adductor tubercle of femur
e. Has a nerve supply including the sciatic and anterior division of obturator nerves

45. The skin over the femoral triangle is supplied by


a. Ilioinguinal nerve
b. Obturator nerve
c. Medial femoral cutaneous nerve
d. Lateral femoral cutaneous nerve
e. Genitofemoral nerve

46. The great saphenous vein


a. Is a continuation of the lateral marginal vein of the foot
b. Runs between the 2 heads of gastrocnemius
c. Pierces the cribriform fascia in the upper thigh
d. Can be found immediately below and lateral to the pubic tubercle
e. Does not communicate with varicosities in the superficial veins

47. The hip joint


a. Derives its stability largely from the shape of its articular surfaces
b. Has the ischiofemoral as its strongest ligament
c. Is only supplied by the obturator and sciatic nerves
d. Is limited in full extension by the pubofemoral ligament
e. Is flexed largely by sartorius and rectus femoris
1. e 25. c
2. c 26. e
3. b 27. e
4. e 28. c
5. c 29. e
6. d 30. a
7. a 31. c
8. d 32. ??
9. d 33. c
10. c 34. b, c
11. c 35. d
12. c 36. e
13. c 37. A
14. c 38. C
15. e 39. C
16. e 40. D
17. a 41. C
18. b 42. B
19. b 43. D
20. a 44. A
21. d 45. E
22. e 46. C
23. c 47. A
24. c
Ankle and foot

1. The ankle joint is


a. Dorsiflexed by tibialis posterior and peroneus tertius
b. Fixed in its own axis of rotation
c. Crossed by the anterior tibial artery lateral to the extensor hallucis longus tendon
d. Supported by the lateral deltoid ligamanet
e. Innervated by the sural and superficial peroneal nerves

2. A 25 y.o. man is unable to plantarflex his foot. The most likely cause is damage to
a. The superficial peroneal nerve
b. L5 nerve root
c. Tibial nerve
d. Gastrocnemius
e. Soleus

3. Dorsalis pedis artery


a. Lies medial to the tendon of extensor hallucis longus
b. Lies lateral to the digital branch of the deep peroneal nerve
c. Crosses superficial to the tendon of extensor hallucis brevis
d. Terminates as the arcuate artery
e. Joins the lateral plantar artery to form the plantar arch

4. Following an injury to the leg, a patient is unable to dorsiflex their foot. Which nerve is most likely to be
damaged?
a. Deep branch of the common peroneal nerve
b. Sural nerve
c. Superficial branch of the common peroneal nerve
d. Saphenous nerve
e. None of the above

5. Which is not a component of the second layer of the sole of the foot?
a. Tendon of flexor hallucis longus
b. Abductor hallucis
c. Flexor accessorius
d. The lumbrical muscles
e. Tendon of flexor digitorum longus

6. What movement occurs at the subtalar joint


a. Inversion
b. Eversion
c. Equinovarus
d. Plantarflexion
e. ?
7. What muscle cause dorsiflexion and inversion of the foot
a. Tibialis anterior
b. Tibialis posterior
c. Extensor hallucis longus
d. Peroneus tertius
e. ?

8. What passes superficial to the superior flexor retinacula of the foot


a. ?
b. ?
c. ?
d. ?
e. ?

9. Regarding the ossification centres of the bones of the foot, which is incorrect
a. There are 3 at birth
b. 5th metatarsus has 3 ossification centres
c. Metatarsals have 2 centres
d. ?
e. ?

10. Regarding the structures passing beneath the flexor retinaculum of the ankle which is correct?
a. Posterior tibial artery lies anterior to the flexor digitorum longus
b. Flexor hallucis longus lies anterior to posterior tibial artery
c. The posterior tibial artery lies anterior to the tibial nerve
d. Flexor hallucis longus is the most anterior structure
e. Flexor digitorum longus is the most posterior structure

11. Regarding the medial longitudinal arch


a. Its stability is due to its bony structures
b. Flexor hallucis brevis acts as a bowstring
c. The plantar aponeurosis is of minimal importance
d. Peroneus longus supports the posterior portion
e. None of the above

12. At the ankle


a. The deltoid ligament attaches to the tibia and the calcaneous
b. The talus is more narrow anteriorly
c. The capsule attaches to the neck of the talus
d. In plantar flexion there is also eversion
e. Dorsiflexion is produced by tibialis anterior and peroneus brevis

13. All of the following are ankle joint ligaments except


a. Posterior tibio-fibular ligament
b. Deltoid ligament
c. Inferior transverse ligament
d. Posterior talofibular ligament
e. Oblique ligament
14. Concerning the innervation of the foot
a. The medial plantar nerve supplies the first 3 lumbricals
b. The skin of the first cleft is supplied by the superficial peroneal nerve
c. The plantar digital nerves supply the nail bed
d. All interossei are supplied by the medial plantar nerve
e. The medial and lateral plantar nerves are branches of the common peroneal nerves

15. The talus


a. Has its sole articulation with calcaneous in the talocalcaneonavicular joint
b. Has a long plantar ligament attached to its plantar surface
c. Has an upper articular surface narrow in front and broad behind
d. Receives a good blood supply from dorsalis pedis, posterior tibial and peroneal arteries
e. Is connected to navicular by the spring ligament

16. The ankle joint


a. Is stabilised laterally by the deltoid ligament
b. Relies on the fibula for weight bearing
c. Acts purely as a hinge joint
d. Has 3 ligaments radiating from the lateral malleolus
e. Owes stability primarily to the shape of the tibiotalar articulating surface

17. The lumbrical muscles of the foot


a. Pass forward on the lateral sides of the metatarsophalangeal joints
b. Arise from the tendons of flexor digitorum longus
c. Are all supplied by the lateral plantar nerve
d. Have no real function in walking or running
e. Do not insert into the extensor expansions

18. With regard to the calcaneus


a. It is the largest of the tarsal bones
b. It has a convex medial surface
c. The peroneal trochlea is found on it medial surface
d. It articulates with the talus, navicular and cuboid
e. The upper surface carries articular surfaces on its posterior half

19. Regarding the ankle joint


a. The lateral ligament has 2 layers
b. The posterior talofibular ligament is strong and runs horizontally
c. The deep portion of the medial ligament is triangular in shape
d. The superficial portion of the medial ligament is rectangular in shape
e. The nerve supply of the capsule is by the superficial peroneal nerve

20. Under the extensor retinaculum of the foot the most lateral structure is
a. Sural nerve
b. Dorsalis pedis artery
c. Peroneus tertius
d. Extensor digitorum longus
e. Extensor hallucis longus
21. With regard to the cutaneous innervation of the lower limb
a. Superficial peroneal nerve supplies the first inter-digital cleft
b. Sural nerve supplies the medial malleolus
c. Deep peroneal nerve supplies the third inter-digital cleft
d. The medial plantar nerve supplies a greater area than the lateral
e. Branches of the tibial nerve supply much of the dorsum of the foot

22. Regarding the ankle joint


a. The capsule is attached anteriorly to the neck of the talus
b. It has a fixed rotation of axis
c. The weight bearing surfaces are the upper facet of the talus, the inferior facet of the tibia and the medial
and lateral malleoli
d. The lateral ligament is made up of three separate bands that all insert into the talus
e. In full plantarflexion a significant amount of inversion and eversion is possible at the ankle joint

23. All of the following structures pass deep into the superior extensor retinaculum at the ankle except
a. Extensor digitorum longus
b. Deep peroneal nerve
c. Anterior tibial artery
d. Superficial peroneal nerve
e. Peroneus tertius

24. The dermatome supplying the great toe is usually supplied by


a. L3
b. L4
c. L5
d. S1
e. S2

1. c 13. e
2. c 14. c
3. e 15. d
4. a 16. d
5. b 17. b
6. a/b 18. a
7. a 19. b
8. ? 20. c
9. ? (a, b, c true) 21. d
10. c 22. a
11. e 23. d
12. c 24. c
Knee and leg
1. Posterior tibial artery
a. Divides superior to the flexor retinaculum
b. Divides into the medial and lateral plantar arteries
c. Branches from 2 plantar arteries in the foot
d. Lateral plantar branch supplies the big toe
e. Divides inferior to the flexor retinaculum

2. Regarding the knee joint


a. middle geniculate artery supplies the cruciate ligament
b. Bursa beneath medial head gastrocnemius usually communicate with joint
c. Rotation takes place below the menisci
d. Coronary ligament attaches menisci to the articular margins of tibia and femur
e. All of the above

3. Popliteal fossa
a. The floor is provided by biceps femoris
b. The sural communicating nerve pierces the roof
c. Popliteal lymph nodes lie next to the popliteal artery
d. The recurrent genicular nerve pierces the roof
e. Superior and inferior geniculate nerves supply the medial ligament

4. The stability of the weight bearing flexed knee is maintined by


a. Anterior cruciate ligament
b. Ilio-tibial tract
c. Posterior cruciate ligmanet
d. Popliteus and posterior cruciate ligament
e. Arcuate popliteal ligament and anterior cruciate ligament

5. The short saphenous vein


a. Lies anterior to the lateral malleolus
b. Is accompanied by the saphenous nerve
c. Drains into the great saphenous vein
d. Drains to the lateral margin of the foot
e. Lies deep to the deep fascia of the calf

6. Which is not true of the tendo achilles


a. It inserts into the middle third of the posterior surface of the calcaneous
b. It is invested in a synovial sheath
c. It is formed from the soleus and gastrocnemius
d. A bursa lies between the tendon and the upper third of calcaneous
e. A bursa lies between it and the deep fascia near its insertion

7. The anterior tibial artery


a. Pierces the interosseous membrane
b. Supplies the lateral compartment of the leg
c. Lies lateral to the deep peroneal nerve
d. Lies lateral to tibialis anterior
e. Gives the nutrient artery to the tibia
8. The suprapatellar bursa
a. Does not communicate with the knee joint
b. Lies in front of the vastus intermedius muscle
c. Extends 5cm or more above the patella
d. Lies deep to the patella retinacula
e. None of the above

9. Regarding the extensor compartment of the lower leg, all of the following statements are true, except
a. The tibialis anterior muscle is supplied by the deep peroneal and recurrent genicular nerves (L4)
b. Extensor digitorum longus and peroneus tertius muscle lie lateral to the tibialis anterial artery
throughout
c. The deep peroneal nerve arises within the peroneus longus muscle
d. The extensor digitorum longus dorsiflexes the lateral toes
e. The extensor hallucis longus arises from the middle two-fourths of the tibia and adjacent interosseous
membrane

10. Regarding lower leg structures


a. The anterior tibial artery lies lateral to tibialis anterior
b. The deep peroneal nerve originates in the popliteal fossa
c. Peroneus longus is supplied by the deep peroneal nerve
d. Extensor digistorum longus lies medial to tibialis anterior
e. The tibia receives a nutrient vessel from the anterior tibial

11. Tibialis anterior inserts into


a. Navicular
b. Medial cuneiform and base of first metatarsal
c. Lateral cuneiform and base of 5th metatarsal
d. Middle three metatarsals
e. Medial cuneiform and base of 1st phalanx

12. Tibialis posterior inserts into


a. The base of the first metatarsal
b. The navicular
c. Base of 2nd and third metatarsals
d. The cuboid
e. None of the above

13. Factors that stabilise the patella include all except


a. Forward prominence of the lateral condyle
b. Forward prominence of the medial condyle
c. Medial patellar retinacular fibres
d. Vastus medialis fibres that insert into the lowest part of the patella
e. The tone in vastus medialis

14. Popliteus muscle


a. Is a weak flexor of the knee
b. Is intracapsular
15. Regarding the menisci of the knee joint
a. Posterior cruciate is medial
b. Medial meniscus is avascular
c. Fold of synovium lies posterior to anterior cruciate
d. Anterior horn of medial meniscus is attached to medial tibial condyle

16. Which ligament forms part of the knee capsule


a. Lateral collateral
b. Medial collateral
c. Anterior cruciate
d. Posterior cruciate
e. Popliteus tendon

17. With regard to peroneus longus muscle


a. The tendon lies below peroneus brevis in the lateral compartment of the leg
b. It is supplied by the superficial peroneal nerve (L5, S1)
c. Arises from the lower 2/3 s of the peroneal surface of fibula
d. The action is to invert the foot
e. It has a broad tendon in comparison to the narrower tendon of peroneus brevis

18. Tibialis anterior


a. Everts the foot
b. Is supplied by the superficial peroneal nerve
c. Arises from the lower 2/3s of the tibia and interosseous membrane
d. Lies medial to the anterior tibial artery
e. Lies lateral to peroneus tertius

19. Of muscles and tendons crossing the knee


a. Popliteus medially rotates the femur to unlock the knee from extension
b. Soleus crosses the posterolateral aspect of the joint
c. Semitendinosis tendon passes anterior to the medial condyle
d. Gluteus maximus crosses the knee joint by way of the iliotibial tract
e. Biceps femoris inserts into the anterolateral aspect of the tibia

20. Regarding innervation of flexion/extension of the knee


a. All muscles of the quadriceps femoris are supplied by L3/4
b. Vastus medialis are intermedius are supplied by the same branch of the femoral nerve
c. Flexion of the knee by hamstrings is supplied solely by tibial component of sciatic nerve
d. Flexor innervation of the knee can be tested by knee jerk L3
e. Traumatic fracture dislocation of hip affects knee extension greater than flexion

21. Tibialis anterior


a. Is supplied by the superficial peroneal nerve
b. Has a synovial sheath that continues below superior extensor retinaculum
c. Dorsiflexes and everts the foot
d. Inserts into the lateral cuneiform
e. Originates from the tibia and fibula
22. With regard to the stability of the knee joint
a. The posterior cruciate ligament prevents the femur from slipping posteriorly on the tibia
b. The lateral collateral ligament is more prone to damage than the medial
c. The medial meniscus is more prone to damage than the lateral
d. The integrity of the anterior cruciate ligament is most important when walking down stairs
e. The fit of the articular surfaces of the tibia and femur is the most important factor in providing stability
to the knee

23. The ligament important in producing the screw home position in full extension of the knee is the
a. Anterior cruciate ligament
b. Posterior cruciate ligament
c. Arcuate popliteal ligament
d. Patellar retinacula
e. All of the above

24. The cruciate ligaments would be anaesthetized by injury to


a. Femoral nerve
b. Common peroneal nerve
c. Tibial nerve
d. Obturator nerve
e. None of the above

25. The cruciate anastomsosis


a. Is supplied by the inferior branch of the medial circumflex femoral artery
b. Is supplied by the descending branch of the first perforating artery
c. Begins at the level of the greater trochanter
d. Is supplied by the transverse branch of the lateral circumflex femoral artery
e. Gives blood supply to the head of the femur

26. In the popliteal fossa


a. The sural nerve branches from the common peroneal nerve
b. The roof is formed by biceps femoris
c. The popliteal vein lies between the popliteal artery and tibial nerve
d. The inferomedial border is soleus
e. The politeal artery runs vertically

27. Politeus
a. Arises from the tibia above the condyles
b. Slopes upwards and medially
c. Inserts into the lateral meniscus
d. In innervated by a branch of the common peroneal nerve
e. Acts to “lock” the knee in full extension

28. With regards to the knee joint


a. The medial collateral ligament extends 8cm below the joint margin
b. The medial collateral ligament is extra-articular
c. The tenson of politeus is intra-articular
d. The lateral meniscus is more C-shaped
e. All of the avove
29. Tibialis anterior
a. Dorsiflexes and everts the foot
b. Arises from the upper 2/3s of the fibula
c. Inserts into the medial cuneiform
d. Shares its site of insertion with peroneus tertius
e. Is supplied by L5,S1

30. In the lateral compartment of the leg


a. The muscles are supplied by the deep peroneal nerve
b. The peroneus longus muscles arise only from the fibula
c. The peroneal muscle tendons are bound at the lateral malleolus by the inferior peroneal retinaculum
d. The peroneal muscles share a common synovial sheath at the lateral malleolus
e. The blood supply is from the anterior tibial artery

1. 6. 11. 16. 21. B 26. C

2. 7. 12. 17. 22. C 27. C

3. 8. 13. 18. 23. A 28. E

4. 9. 14. 19. D 24. C 29. C

5. 10. 15. 20. A 25. D 30. D


Section 1

Upper Limb Anatomy

1) With regard to the pectoral girdle:


a) contains three joints, the sternoclavicular, the acromioclavicular and the glenohumeral
b) serratus anterior, the rhomboids and subclavius attach the scapula to the axial skeleton
c) pectoralis major and deltoid are the only muscular attachments between the clavicle and the upper limb
d) teres major provides attachment between the axial skeleton and the girdle

2) Choose the odd muscle out as regards insertion/origin:


a) supraspinatus
b) subscapularis
c) biceps
d) teres minor
e) deltoid

3) Which muscle does not insert in or next to the intertubecular groove of the upper humerus?
a) pectoralis major
b) pectoralis minor
c) latissimus dorsi
d) teres major

4) Identify the incorrect pairing for testing muscles:


a) latissimus dorsi – abduct to 60° and adduct against resistance
b) trapezius – shrug shoulders against resistance
c) rhomboids – place hands on hips and draw elbows back and scapulae together
d) serratus anterior – push with arms outstretched against a wall

5) Identify the incorrect innervation:


a) subclavius – own nerve from the brachial plexus
b) serratus anterior – long thoracic nerve
c) clavicular head of pectoralis major – medial pectoral nerve
d) latissimus dorsi – dorsal scapular nerve
e) trapezius – accessory nerve

6) Which muscle does not extend from the posterior surface of the scapula to the greater tubercle of the
humerus?
a) teres major
b) infraspinatus
c) supraspinatus
d) teres minor

7) With regard to action, which muscle is the odd one out?


a) teres minor
b) deltoid
c) teres major
d) subscapularis
8) Which statement is INCORRECT?
a) the muscles of the rotator cuff are deemed to be such because all their tendons fuse with the lateral
part of the shoulder capsule and are attached to the humerus near the joint
b) the capsule of the shoulder joint is attached at the line of the anatomical head except inferiorly where it
extends to the level of the surgical neck
c) the subacromial bursa lies between the tendon of supraspinatus and the coraco-acromial ligament and
communicates with the shoulder joint
d) the long tendon of biceps lies intracapsular and is sheathed by synovial membrane that allows it to slide
with movement

9) Stabilising factors of the shoulder joint include all but:


a) a tight capsule
b) tendons that fuse with the capsule
c) glenohumeral and coracohumeral ligaments
d) labrum
e) splinting of the humeral head between the tendons of biceps and triceps

10) Regarding the brachial plexus, which is INCORRECT?


a) it is derived from the anterior rami of C5-T1 after they have given off segmental supply to the
prevertebral and scalene muscles
b) the roots give off three branches including the long thoracic nerve to latissimus dorsi
c) the trunks give off one branch
d) the cords are divided into anterior and posterior divisions that supply the flexor and extensor
compartments respectively and give off 13 branches
e) the lateral cord supplies part of the median nerve

11) Regarding lymph nodes, the lateral side of the arm and forearm is drained initially to the:
a) supratrochlear nodes
b) posterior axillary nodes
c) infraclavicular nodes
d) central axillary nodes

12) Which of the following has some nerve supply from the radial nerve?
a) long head of biceps
b) coracobrachialis
c) short head of biceps
d) brachialis

13) As it emerges from the axilla, the median nerve lies where with regards to the brachial artery?
a) lateral
b) anterior
c) medial
d) posterior
14) With regards to the posterior compartment of the arm, which is FALSE?
a) the medial head of triceps lies deep to the long and lateral heads
b) triceps inserts onto the upper surface of the olecranon
c) midshaft fracture of the humerus can damage the radial nerve resulting in paralysis of triceps
d) the medial intermuscular septum divides it from the anterior compartment and runs from the axilla to
the elbow

15) Blood supply to the upper limb, which is FALSE?


a) the subclavian artery is divided schematically by scalenus anterior
b) usually all branches of the subclavian come from the first segment
c) the dorsal scapular branch may arise from the third segment
d) pectoralis major schematically divides the axillary artery into three parts
e) the acromial branch of the thoracoacromial trunk accompanies the cephalic vein in the deltopectoral
triangle

16) Regarding the brachial plexus, which is FALSE?


a) the nerve to serratus anterior comes from the anterior rami of C5-C7
b) the suprascapular nerve arises from C5 anterior ramus
c) the divisions are at the level of the clavicle
d) the thoracodorsal nerve arises from the posterior cord
e) the radial nerve is the largest branch of the brachial plexus

17) Regarding the brachial plexus:


a) the lateral cord contains fibres from C5, 6, 7 & 8
b) the posterior cord has fibres from C5, 6, 7, 8 & T1
c) the medial cord has fibres from C8 and T1
d) the suprascapular nerve arises from C5
e) the ulnar nerve is a continuation of the medial cord

18) Which is CORRECT?


a) medial pectoral nerve C7 C8
b) ulnar nerve C7 C8 T1
c) dorsal scapular nerve C5 C6
d) long thoracic nerve C6 C7 C8
e) musculocutaneous C5 C6

19) Regarding the brachial plexus:


a) the roots lie behind scalenus medius muscle
b) the trunks are formed behind the clavicle
c) at the first rib, the cords are formed
d) the cords give branches around second part of artery

20) In the cubital fossa:


a) median nerve lies lateral to the biceps tendon
b) radial nerve and interosseous branch lies beneath the brachialis
c) radial artery passes between heads of pronator teres
d) brachial artery lies beneath biceps aponeurosis
e) radial nerve leaves fossa between heads of supinator
21) The clavicle:
a) ossifies at eight weeks
b) has atypical synovial joints at both ends
c) articulates with the first rib
d) is more curved in females
e) usually fractures between deltoid tubercle and coranoid tubercle

22) Regarding innervation of hand muscles:


a) opponens pollicis may be supplied by ulnar nerve
b) opponens digiti minimi may be supplied by median nerve
c) two radial interossei are usually supplied by median nerve
d) nail beds are supplied 3½ to 1½ by branches of radial and ulnar nerves
e) adductor pollicis is supplied by muscular (recurrent) branch of median nerve

23) At the wrist / carpal tunnel:


a) flexor retinaculum attaches to scaphoid and trapezoid laterally
b) all superficial and deep flexors, except flexor pollicis longus, share a common flexor sheath
c) the ulnar nerve lies medial to pisiform
d) tendons of flexor digitorum remain attached until they reach the palm
e) median nerve lies beneath flexor retinaculum between flexor digitorum superficialis and flexor pollicis
longus

24) Axillary artery:


a) first part is separated from the cords by axillary sheath
b) lies posterior lateral to vein – all three parts
c) medial root of median nerve crosses behind ????? to join lateral root.
d) leaves axillar through quadrangular space
e) supplies the breast via thoracoacromial branch

25) All the following arise from the common extensor origin EXCEPT:
a) extensor carpi radialis brevis
b) extensor carpi radialis longus
c) extensor digitorum
d) extensor digitorum minimi
e) extensor carpi ulnaris

26) Regarding triceps:


a) lateral head arises from humerus below radial groove
b) midshaft humerus fractures may paralyse triceps
c) has an insertion into the elbow joint capsule
d) aids in adduction of shoulder
e) is pierced by ulnar nerve

27) Which of the following pairs do not match with regard to mode of ossification?
a) ribs and cranium
b) clavicle and humerus
c) femur and 1st metatarsal
d) patella and pisiform
e) mandible and clavicle
28) Which joint is the odd one out with regard to degrees of freedom?
a) 1st carpometacarpal joint
b) radiohumeral joint
c) sternoclavicular joint
d) acromioclavicular joint
e) radiocarpal joint

29) Which of the statements regarding ligaments is FALSE?


a) ligaments are relatively avascular
b) final healing following sprains usually restores full strength
c) torn ligaments may predispose to dislocation
d) Sharpeg’s fibres penetrate the bone
e) a healed sprain may be predisposed to reinjury

30) Regarding cartilage, which is FALSE?


a) it is essentially avascular
b) hyaline cartilage contains hyaluronic acid
c) rib cartilage is elastic type
d) TMJ is fibrous
e) all contain mucopolysaccharides

31) Regarding types of joints, which pairing is CORRECT?


a) diarthrosis – cranial suture
b) synarthrosis – symphysis pubis
c) amphiarthrosis – sternoclavicular joint
d) cromphosis – intervertebral joints
e) syndesmoses – tibiofibular joint

32) Types of muscles, which pairing is INCORRECT?


a) unipennate – flexor pollicis longus
b) bipennate – 4th lumbrical
c) fusiform – supraspinatus
d) bipennate – soleus
e) multi-pennate – anterior deltoid

33) Regarding muscle strength, which is NOT a factor?


a) resting length of muscle
b) cross sectional area
c) lever arm length
d) the extent to which the muscle is contracted
e) configuration of fibres, eg fusiform, c.f. bipennate

34) Regarding the autonomic nervous system, visceral pain is not referred to L3-5 and S1 because:
a) there are no visceral afferents related to these lumbar splanchnic nerves
b) there are no white rami communicans to these spinal nerves
c) there are no sympathetic ganglia associated with theses spinal segments
d) there is no sympathetic efferent supply to these spinal nerves
e) there are no grey rami communicans associated with the autonomic ganglia of L3-S1 spinal nerves
Section 1

Upper Limb Anatomy – Answers

1 C
2 E
3 B
4 A
5 D
6 A
7 A
8 C
9 A
10 B
11 C
12 D
13 A
14 C
15 D&B
16 All are correct
17 A
18 No answer
19 No answer
20 No answer
21 No answer
22 No answer
23 No answer
24 No answer
25 No answer
26 No answer
27 B
28 A
29 B
30 C
31 E
32 E
33 A
34 B
Section 2

1) At the elbow joint:


a) the tilt of the trochlear of the humerus is the main cause for the carrying angle of the elbow
b) the capsule is not attached to the radius
c) the annular ligament is attached to the head and neck of the radius
d) the middle band is the strongest of the three bands that make up the ulnar collateral ligament
e) the carrying angle is the angle between the extended ulna and the vertical

2) Regarding palmar spaces:


a) the hypothenar space contains the long tendon of abductor digiti minimi
b) the midpalmar space is deep to the common synovial sheath and flexor tendons
c) the midpalmar space is not continuous with the three ulnar lumbrical canals
d) the thenar space is open at the wrist
e) prevent spread of infection

3) Which is NOT an origin of supinator


a) radial tuberosity
b) radial collateral ligament
c) lateral epicondyle of humerus
d) supinator crest of ulnar
e) aponeurosis overlying supinator muscle

4) Regarding the nerves and vessels of the arm:


a) the circumflex vessels and the axillary nerve enter the extensor compartment in the axilla through the
triangular space
b) the ulnar nerve pierces the lateral intermuscular septum in the lower third of the arm
c) the median nerve crosses obliquely in front of the radial artery in the arm
d) supratrochlear lymph nodes lie in the subcutaneous ????? just above the medial epicondyle
e) the basilic vein is lateral to the cephalic vein

5) Brachial plexus:
a) the five roots lie in front of scalenus anterior muscle
b) the anterior division of the central trunk runs on as the medial cord
c) the suprascapular nerve is the only branch from the trunks
d) the radial nerve is a branch of the lateral cord
e) the ulna nerve is a branch of the posterior cord

6) The musculocutaneous nerve passes through which muscle?


a) coracobrachialis
b) short head of biceps
c) brachialis
d) medial head of triceps
e) long head of biceps
7) What structure does NOT lie in the anatomical snuff box?
a) cephalic vein
b) radial artery
c) radial styloid
d) first metacarpal bone
e) extensor pollicis longus

8) Latissimus dorsi:
a) is an accessory muscle of inspiration and expiration
b) is supplied by the dorsal scapular nerve
c) forms the lower border of the medially axillary fold
d) laterally rotates the humerus
e) lies superficial to trapezius at its upper border

9) Regarding the shoulder joint, which is INCORRECT?


a) full abduction requires medial rotation
b) the long head of biceps is intracapsular
c) the subacromial bursa is attached to the coracoacromial ligaments
d) flexion involves pec major, deltoid, coracobrachialis and biceps
e) supraspinatus initiates abduction

10) In the forearm:


a) the median nerve passes between the two heads of pronator teres
b) the ulnar nerve lies deep to flexor digitorum profundus
c) superficial fibres of flexor digitorum superficialis gives rise to the tendons for index and middle fingers
d) the radial artery is on the lateral side of the radial nerve
e) the fibres of the interosseous membrane run obliquely down from ulna to radius

11) What structure does NOT pierce the clavipectoral fascia?


a) cephalic vein
b) lymphatics
c) lateral thoracic artery
d) lateral pectoral nerve
e) thoracoacromial artery

12) Regarding the thumb:


a) abductor pollicis longus originates from both radius and ulna
b) opponens pollicis rotates the first metacarpal on the triquetral
c) adductor pollicis inserts on to the radial sesamoid of the thumb, then the base of the proximal phalanx
d) nerve supply is by the median nerve (C7, C8)
e) adductor pollicis lies superficial to the thenar space

13) Which artery is the main supply of triceps?


a) dorsal scapular artery
b) brachial artery
c) profunda brachii artery
d) radial artery
e) posterior circumflex humeral artery
14) Teres major:
a) receives its nerve supply from the lateral cord of the brachial plexus
b) is part of the medial wall of the axilla
c) forms the medial border of the triangular space
d) is separated from teres minor by the long head of triceps
e) has the same nerve supply as teres minor

15) Regarding the brachial plexus:


a) the dorsal scapular nerve is the only branch from the trunks
b) the axillary nerve is derived from C5, 6, 7, 8, T1
c) the ulnar nerve is the largest branch of the whole plexus
d) the axillary nerve passes below teres major
e) the thoracodorsal nerve supplies lateral dorsi

16) Flexor pollicis longus:


a) is a bipennate muscle
b) arises from the common flexor origin
c) pierces the flexor retinaculum at the wrist
d) inserts into the radial border of the proximal phalanx
e) has fleshy fibres to a point, just above the wrist

17) Which nerve supplies serratus anterior?


a) axillary nerve (C5, C6)
b) long thoracic nerve (C5, C6, C7)
c) musculocutaneous nerve (C5, C6)
d) thoracodorsal nerve (C6, C7, C8)
e) suprascapular nerve (C5, C6)

18) At the elbow joint:


a) there is no communication with the proximal radioulnar joint
b) the capsule is attached to the neck of the radius
c) the radial collateral ligament is made up of three bands
d) the ulnar nerve passes between the anterior and posterior bands of the ulnar collateral ligament
e) the carrying angle is greater in men

19) Which structure does NOT insert into the flexor retinaculum?
a) abductor pollicis brevis
b) flexor digiti minimi brevis
c) palmaris longus
d) opponens pollicis
e) flexor pollicis brevis

20) Which nerve does NOT make contact with periosteum?


a) radial nerve
b) axillary nerve
c) median nerve
d) ulnar nerve
e) anterior interosseous nerve
21) Regarding the clavicle, which is false?
a) the clavicle is longer and its curvatures more pronounced in the male
b) the articulating sternal end is covered by fibrocartilage
c) it is the first bone to ossify in the foetus
d) it has four named ligaments attached to it
e) fractures of the clavicle tend to occur between the costoclavicular and the coracoclavicular ligaments

22) Which is true of muscles of the pectoral girdle?


a) “direct” muscles are inserted into the clavicle or scapula from the axial skeleton, eg pectoralis major
b) “indirect” attachment to the axial skeleton is represented by serratus anterior
c) the sternocostal fibres of pectoralis major from the 6th costal cartilage are inserted higher on the lateral
lip of the intertubecular soleus than the fibres from the first cartilage
d) biceps muscle gives no stability to the shoulder joint
e) trapezius is the only muscle to be supplied by all five segments of the brachial plexus

23) The clavipectoral fascia is pierced by all but one of the following structures:
a) lymphatic drainage from the infraclavicular nodes to apical axillary nodes
b) cephalic vein
c) lateral pectoral nerve
d) thoracoacromial artery
e) pectoralis minor

24) With respect to the axilla:


a) the thoracodorsal nerve runs posterior to the mid axillary line on serratus anterior, which it supplies
b) the axillary artery is divided into three parts by scalenus anterior
c) the lateral wall is made up of latissimus dorsi tendon, subscapularis, teres major
d) the lateral thoracic vein is connected by the thoracoepigastric vein to the superficial epigastric vein,
therefore bypassing the IVC in its obstruction
e) the axillary vein commences at the upper border of teres major as a continuation of the basilic vein

25) With respect to the brachial plexus:


a) it consists of the entire anterior rami of C5 → T1
b) there are five roots, three trunks, five divisions and three cords
c) there are two branches from the divisions
d) there are a total of 13 branches from the cords
e) there are two branches from the roots

26) With respect to the brachial plexus:


a) the lateral cord lies in the axilla
b) the median nerve is the largest branch of the whole plexus
c) the roots lie within the posterior triangle of the neck
d) the ulnar nerve is a branch of the lateral cord
e) the musculocutaneous nerve is a branch of the medial cord
27) The blood supply to the breast involves all but one of the following:
a) lateral thoracic artery
b) long thoracic artery
c) internal thoracic artery
d) posterior intercostal artery
e) thoracoacromial artery

28) Which muscle takes origin (in part) from both the medial and lateral intermuscular septa?
a) biceps
b) brachioradialis
c) extensor carpi radialis longus
d) supinator
e) triceps

29) The carpus:


a) there are five extensor tunnel compartments
b) the extensor expansion attaches to the anterolateral border of the radius above the styloid process, and
distally to the pisiform and trapezoid bones
c) the radiocarpal joint is an uniaxial synovial joint
d) there are no muscular attachments to the extensor surface of the carpus
e) the bones palpable in the anatomical snuff box are the radial styloid, triquetral, scaphoid and base of
first metacarpal

30) Which is true?


a) the flexor synovial sheath is only continuous from wrist to distal phalanx in the thumb
b) the medial cutaneous nerve is the smallest nerve branch of the brachial plexus
c) the capitate bone within the carpus is the last of these to ossify
d) the pisiform bone is the first bone of the carpus to ossify
e) superficial lymphatics lie with arteries, deep lymphatics with veins
Section 2

Answers

1 B
2 B
3 A
4 D
5 C
6 A
7 E
8 A
9 A
10 A
11 C
12 A
13 C
14 D
15 E
16 E
17 B
18 D
19 C
20 C
21 D
22 C
23 E
24 D
25 D
26 A
27 B
28 E
29 D
30 B
Section 4

Upper Limb

1) Which is true?
a) epidermis derives from mesoderma
b) the sweat glands, sebaceous glands are mesodermal in origin
c) the colour of the skin is determined by the number of melanocytes in the skin
d) the dermis has a mesodermal origin

2) Regarding sweat glands, which is true?


a) the main nerve supply is via cholinergic sympathetic fibres
b) the main nerve supply is via adrenergic sympathetic nerves
c) the sweat glands derive from the mesoderm
d) the normal tubular sweat glands undergo cyclical changes with the menstrual cycle
e) the highest number of sweat glands are found on the soles and palms

3) Regarding cartilage, which is true?


a) they have a rich blood supply
b) the intervertebral discs are hyaline cartilages
c) the hyaline and fibrocartilages never calcify
d) the elastic cartilage never calcifies
e) the commonest cartilage type is elastic cartilage

4) Regarding muscles, which is true?


a) the cardiac muscle is more powerful than the other two muscle types
b) the skeletal muscle fibre is spindle shaped
c) the smooth muscles do not have actin and myosin
d) the skeletal muscle contraction causes peristalsis in the GI tract and ureter
e) the cardiac muscle is short, branched, mononuclear and a striated muscle

5) Regarding periosteum, which is TRUE?


a) it is an avascular fibrous tissue
b) it is osteogenic
c) it covers the articular surfaces of long bones
d) it covers the inner surface of the medullary cavity
e) it receives its blood supply from overlying muscle

6) An example of secondary cartilaginous joint include:


a) hip joint
b) manubrio-sternal joint
c) costochondral joint
d) epiphysis joint
e) wrist joint
7) An example of a fibrous joint include:
a) structures of the vault of the skull
b) the vertebral columns
c) pubic symphysis
d) hip joint
e) manubrio-sternal joint

8) Which of the following peripheral fibres have pain and temperature fibres?
a) α neurone
b) β neurone
c) γ neurone
d) δ neurone
e) group B fibres

9) Pectoralis major:
a) is innervated laterally by the lateral pectoral nerve
b) inserts into the medial lip of the intertubercular sulcus
c) receives its arterial supply via the thoracoacromial artery
d) can act as an accessory muscle of inspiration
e) acts with latissimus dorsi and teres minor to adduct the arm

10) Regarding the brachial plexus:


a) the suprascapular nerve arises from the anterior C5, 6 division
b) ulnar nerve often carries fibres from C7
c) the radial nerve leaves the axilla via the quadrangular space
d) the radial artery lies anterior to the medial and lateral roots of the median nerve
e) the long thoracic nerve arises from the C5 nerve root only

11) The subacromial bursa:


a) communicates with the shoulder joint
b) does not extend beyond the lateral aspect of the acromion
c) innervated in part by the dorsal scapular nerve
d) attached superiorly to the conoid trapezoid and conoid ligaments
e) attached inferiorly to the tendon of supraspinatus

12) The subclavius muscle:


a) arises from the costochondral junction of the second rib
b) passes in the subclavian groove on the inferior aspect of the clavicle to attach to the acromion
c) is enclosed by the upper attachment of the clavipectoral fascia
d) is supplied by C7 and C8
e) assists shoulder adduction

13) Pectoralis minor:


a) inserts into the lateral tip of the intertubecular groove of the humerus
b) is a rectangular muscle
c) is a guide for the underlying subclavian artery
d) is superior to the suspensory ligament of the axilla
e) is supplied by the subclavian nerve
14) Teres major:
a) is separated from subscapularis by the quadrangular space in the posterior wall of the axilla
b) is supplied by the lateral subscapular nerve
c) inserts into the lateral lip of the intertubecular groove of the humerus
d) acting alone, it abducts and medially rotates the humerus at the shoulder joint
e) arises from the lateral side of the inferior angle of the ventral aspect of the scapula

15) The shoulder joint:


a) subscapularis, supraspinatus, infraspinatus and teres minor all have rotatory action on the humerus and
their tendons form the rotator cuff with the lateral part of the shoulder capsule
b) the subacromial bursa rolls inwards under the acromion when the arm is adducted
c) the joint capsule is attached to the surgical neck of the humerus inferiorly
d) the articular surface of the head of the humerus is five times the area of the glenoid cavity
e) upward thrust on the humerus will preferentially fracture the coracoacromial arch

16) Regarding the nerves and vessels of the arm:


a) the circumflex vessels and the axillary nerve enter the extensor compartment in the axilla through the
triangular space
b) the ulnar nerve pierces the lateral intermuscular septum in the lower third of the arm
c) the median nerve crosses obliquely in front of the radial artery in the arm
d) supratrochlear lymph nodes lie in the subcutaneous fat just above the medial epicondyle
e) the basilic vein is lateral to the cephalic vein

17) Regarding triceps:


a) the long head is lateral to the medial head
b) it inserts into the posterior aspect of the radial tuberosity
c) attachment to the olecranon is by a tendon only
d) the long head receives two branches of the radial nerve
e) the medial head has origins in both lateral and medial intermuscular septums

18) Regarding the brachial plexus:


a) the medial cord has three branches
b) the lateral cord has fibres from C7, C8 and T1
c) the musculocutaneous nerve is a branch of the medial cord
d) the five roots are found from the posterior rami and C5 – T1 nerves
e) none of the above

19) At the carpal tunnel:


a) the flexor tendon synovial sheath is incomplete on the ulnar side
b) the superficial tendons lie in the same plane
c) the four profundus tendons have not yet separated
d) the median nerve lies lateral to flexor digitorum superficialis
e) median nerve compression causes anaesthesia over the thenar eminence
20) What structure pierces the flexor retinaculum?
a) ulnar nerve
b) flexor carpi radialis tendon
c) palmar branch of median nerve
d) flexor pollicis longus tendon
e) ulnar artery

21) The lumbrical muscles:


a) arise from the four superficial tendons
b) are all bicipital muscles
c) pass along the ulnar side of the metacarpophalangeal joint
d) flex the metacarpophalangeal joint
e) attach directly to the first phalanx

22) The following are true about flexor carpi radialis EXCEPT:
a) it arises from the common flexor origin at the humerus
b) it has its own compartment in the flexor retinaculum
c) the radial artery lies laterally to it at the wrist
d) flexor pollicis longus lies medially
e) it is supplied by the median nerve
f) it inserts into the base of the 2nd and 3rd metacarpals

23) Which is the smallest branch of the medial cord of the brachial plexus?
a) medial pectoral nerve
b) medial root of the median nerve
c) medial cutaneous nerve of the arm
d) medial cutaneous nerve of the forearm
e) ulnar nerve

24) The nerve supply of serratus anterior is:


a) axillary nerve
b) C4
c) dorsal scapular nerve
d) thoracodorsal nerve
e) long thoracic nerve

25) Which muscle arises from both the radius and ulna:
a) extensor pollicis longus
b) extensor pollicis brevis
c) abductor pollicis longus
d) extensor indicis
e) extensor digitorum

26) Which lymphatics do not drain the breast?


a) subscapular nodes
b) infraclavicular nodes
c) lateral axillary nodes
d) parasternal nodes
e) pectoral nodes
27) At the cubital fossa:
a) the median nerve is medial to the brachial artery
b) the biceps tendon separates the brachial artery from the median nerve
c) the radial artery leaves the brachial artery at right angles
d) the medial cutaneous nerve of the forearm runs deep to the bicipital aponeurosis
e) pronator teres forms the floor of the fossa
Section 4

Upper Limb – Answers

1 E
2 A
3 D
4 E
5 B
6 B
7 A
8 D
9 D
10 B
11 E
12 ?
13 ?
14 ?
15 ??
16 ??
17 ?
18 E
19 D
20 B
21 D
22 D
23 C
24 E
25 C
26 C
27 A
Section 5

General Principles

1) Regarding tissues:
a) cartilage is very vascular
b) ligaments do not stretch
c) deep fascia is not sensitive
d) cardiac muscle is nonstriated
e) periosteum is not sensitive

2) An example of a unipennate muscle is:


a) sartorius
b) flexor pollicis longus
c) rectus femoris
d) deltoid
e) tibialis anterior

3) An example of a secondary cartilaginous joint is:


a) distal tibiofibular joint
b) costochondral joint
c) sagittal suture
d) sternal angle joint
e) knee joint

4) Which vessel is not an end-artery?


a) renal artery
b) retinal artery
c) pulmonary artery
d) intercostal artery
e) splenic artery

5) A group C nerve fibre:


a) is up to 20 nm in diameter
b) is myelinated
c) has motor function
d) is fusimotor to muscle spindles
e) is post-ganglionic autonomic

6) Regarding cartilage, which is INCORRECT?


a) it is essentially avascular
b) hyaline cartilage contains hyaluronic acid
c) rib cartilage is elastic type
d) TMJ is fibrous
e) all contain mucopolysaccharides
7) At birth:
a) the transverse diameter of the thorax is thrice the AP diameter
b) the liver is relatively twice as big as that of the adult
c) the suprarenal gland is twice as big as the kidney
d) the spinal cord extends to L5
e) the rib cage is more vertically inclined than in the adult

8) In the foetal skull:


a) the vertical height of the orbit is equal to the combined vertical heights of the maxilla and the mandible
b) the mandible is ossified at birth
c) the anterior fontanelle is closed at the end of the first year
d) the volume of the vault is equal to that of the face
e) the bones of the face and the vault ossify at six years

9) Regarding the sympathetic nervous system:


a) every spinal nerve receives a white ramus communicans
b) efferent post ganglionic fibres are myelinated
c) afferent sympathetic fibres synapse in the sympathetic trunk
d) preganglionic cell bodies lie within the lateral horn cells of the T1-L2 spinal segments
e) each cervical ganglion gives off one ramus communicans

10) Which of the following nerve roots is correctly associated with the corresponding muscle action?
a) L5 – plantar flexion of the foot
b) L2 – knee extension
c) C5 – abduction of the shoulder
d) C8 – abduction of the thumb
e) S1 – extension of the great toe

11) In the skin:


a) apocrine sweat glands are confined to the axillae, breasts and urogenital region
b) dark skinned races possess greater numbers of melanocytes
c) sebaceous glands are abundant on the palms and soles
d) melanocytes predominate in the dermis
e) eccrine glands develop under the influence of the sex hormones

12) Regarding bone:


a) cancellous and compact bone show marked microscopic differences
b) the clavicle ossifies in membrane
c) the bones of the skull and face ossify in cartilage
d) the epiphyseal plates of growing bones are composed of fibrocartilage
e) sesamoid bones are only associated with flexor tendons

13) The metacarpophalangeal joints are:


a) planar
b) ellipsoid
c) hinge
d) saddle
e) ball in socket
14) Regarding the intrinsic muscles of the hand, which of the following is NOT true?
a) the palmar and dorsal interossei are supplied by the deep branch of the median nerve
b) the intrinsic muscles of the thumb are abductor pollicis brevis, flexor pollicis brevis, opponens pollicis ,
adductor pollicis, first palmar and first dorsal interossei
c) opponens pollicis acts only on the carpometacarpal joint
d) their motor supply is derived from segment T1 of the spinal cord
e) the thenar muscles are supplied by the recurrent branch of the median nerve

15) Regarding the synovial flexor sheaths, which of the following is NOT true?
a) three synovial sheaths are found on the front of the wrist
b) a common synovial sheath envelops all the superficialis and profundus tendons
c) the sheath around flexor pollicis longus tendon extends almost to its insertion
d) the flexor carpi ulnaris tendon has a short sheath
e) the ring, middle and index fingers have digital sheaths that do not extend to the common sheath

16) The recurrent branch of the median nerve supplies:


a) opponens digiti minimi
b) first dorsal interosseous
c) adductor pollicis
d) first lumbrical
e) abductor pollicis brevis

17) The corocobrachialis muscle:


a) is functionally important
b) origin = apex of acromion
c) insertion = lateral border of humerus
d) nerve supply = C4, C5
e) is pierced by the musculocutaneous nerve

18) Which structure lies in the deltopectoral groove?


a) median pectoral nerve
b) lateral pectoral nerve
c) cephalic vein
d) basilic vein
e) axillary vein

19) Which lymph nodes drain the ulnar side of the forearm?
a) infratrochlear
b) supratrochlear
c) infraclavicular
d) anterior axillary
e) ulnar trochlear

20) Which does NOT enter posterior compartment of the arm?


a) radial nerve
b) profunda brachii artery
c) ulnar nerve
d) posterior cutaneous nerve of forearm
e) superior ulnar collateral artery
21) The annular ligament of the elbow:
a) has minimal usefulness
b) is attached to margins of the radial notch of the ulna
c) is attached to the head and neck of the radius
d) has common attachment with ulnar collateral ligament
e) is attached to the lateral epicondy????????

22) Extensor pollicis brevis:


a) origin – radius and interosseous membrane
b) lies on ulnar side of snuffbox
c) inserts into the base of the first distal phalanx
d) nerve supply = ulnar nerve
e) joins extensor digitorum tendon at metacarpophalangeal joint

23) Extensor pollicis longus – which is INCORRECT?


a) origin = ulnar just distal to adductor pollicis longus
b) insertion = base of first distal phalanx
c) tendon hooks around Lister’s tubercle (radius)
d) forms radial boundary of snuffbox
e) nerve supply – posterior interosseous nerve (C7, 8)

24) Extensor indicis:


a) origin = radius
b) shares a common synovial sheath with E.D. (?extensor digitorum)
c) tendon lies on radial side of E.D. tendon index finger
d) separate insertion from dorsal expansion E.D.
e) nerve supply = median nerve

25) The extensor retinaculum attaches between:


a) radius and ulna
b) scaphoid and ulna
c) radius and triquetral and pisiform
d) radius and lunate
e) trapezium and ulnar

26) All the following statements concerning the scaphoid bone are true EXCEPT:
a) it articulates with radius proximally in abduction
b) it is the most susceptible of the carpal bones to fracture
c) it participates in the midcarpal joint
d) it receives an attachment for the transverse carpal ligament
e) fracture of the scaphoid is a common cause for median nerve compression in carpal tunnel syndrome

27) All of the following structures pass deep to the transverse carpal ligament EXCEPT the:
a) flexor digitorum superficialis tendon
b) flexor digitorum profundus tendon
c) flexor pollicis longus tendon
d) median nerve
e) ulnar artery
28) Laceration of the recurrent branch of the median nerve results in paralysis of all the following muscles of
the thumb EXCEPT:
a) abductor pollicis brevis
b) deep head of flexor pollicis brevis
c) opponens pollicis
d) superficial head of flexor pollicis brevis

29) Which muscle is the odd one out?


a) pronator teres
b) flexor carpi radialis
c) first lumbrical of the hand
d) fourth lumbrical of the hand
e) flexor pollicis longus

30) Infection in the volar aspect of the little finger can spread to all EXCEPT:
a) distally to the ring finger via the tendon sheath
b) to the flexor sheath of the thumb
c) to the distal forearm through the carpal tunnel
d) rupture of the sheath and spread to deep spaces of the palm
e) ischaemic necrosis may occur to the flexor tendon involved

31) Wrist:
a) the flexor retinaculum runs between the styloid process of the radius and the pisiform and hook of
hamate
b) the median nerve passes beneath the flexor retinaculum between flexor digitorum superficialis and
flexor carpi ulnaris
c) the ulnar nerve lies on the flexor retinaculum with the ulnar artery on its ulnar side
d) the wrist joint involves the radius, ulna, scaphoid, lunate and triquetral bones
e) the radiocarpal joint is separated from the distal radioulnar joint by a triangular fibrocartilage

32) Hand:
a) palmar brevis lies across the base of the thenar eminence
b) abductor pollicis brevis and opponens pollicis both arise from the flexor retinaculum and adjacent
trapezium
c) flexor pollicis brevis lies to radial side of abductor pollicis brevis
d) the muscles of the thenar eminence are usually supplied by the recurrent branch of the median nerve
e) opponens pollicis inserts into the whole of the ulnar border of the first metacarpal

33) Trapezius inserts into:


a) vertebral border scapula
b) scapula spine
c) proximal humerus
d) medial clavicle
e) none of the above
34) Myotome of elbow flexion:
a) C5, 6
b) C6, 7
c) C7, 8
d) C5
e) C6

35) Vincula:
a) papillary ridges of skin that form finger prints
b) superficial fibres of palmar aponeurosis that insert into the skin
c) remnant fibres of palmar interossei inserting into the proximal phalanx at the thumb
d) communication between common flexor sheath and sheath of pollicis longus present in 50% of people
e) vascular synovial folds of flexor tendons

36) Of the hand joints, which is INCORRECT?


a) the midcarpal joint is S shaped
b) joint between hamate and fifth metacarpal is most mobile at four digits
c) the first carpometacarpal joint is reinforced by the medial and palmar ligaments
d) palmar ligaments of metacarpophalangeal joints limit extension of joint
e) interphalangeal joints ????have to obliquely place collateral ligaments as a mechanism of tightening re
flexion and extension

37) Which is true of brachial plexus?


a) the trunks lie behind scalene muscle
b) accessory phrenic nerve fibres run to superior mediastinum with long thoracic nerve
c) median nerve divides at the carpal tunnel, lateral branch supplies thenar muscles and medial branch
supplies lumbricals (2)
d) ulnar nerve in 95% of cases picks up C7 fibres from lateral cord
e) branches of radial nerve rise just proximal to their destination
Section 5

General Principals – Answers

1) B
2) B
3) D
4) D
5) E
6) C
7) B
8) A
9) D
10) C
11) A
12) B
13) D
14) A
15) D
16) C
17) E
18) C
19) B
20) E
21) B
22) A
23) D
24) B
25) C
26) E
27) E
28) B
29) D
30) A
31) E
32) D
33) B
34) A
35) E
36) C
37) D
Section 6

Upper Limb

1) The radial nerve gives rise to all the following except the:
a) posterior cutaneous nerve of the arm
b) lower lateral cutaneous nerve of the arm
c) posterior cutaneous nerve of the forearm
d) posterior interosseous nerve
e) medial cutaneous nerve of the arm

2) Which of the following is INCORRECT? Pectoralis minor:


a) arises from the 3rd, 4th and 5th ribs
b) inserts into the coracoid process of the scapula
c) is innervated by both pectoral nerves
d) is an important landmark to the underlying axillary artery
e) is a medial rotator and adductor of the arm

3) Which of the following is INCORRECT? Pectoralis major:


a) consists of clavicular and sternocostal heads
b) is innervated by C6 to T1
c) medially rotates and abducts the arm
d) assists flexion at the shoulder
e) can act as an accessory muscle of respiration

4) The nerve supply of latissimus dorsi is from the:


a) pectoral nerves
b) thoracodorsal nerve
c) axillary nerve
d) long thoracic nerve
e) dorsal scapular nerve

5) The nerve supply of rhomboid major and rhomboid minor is from the:
a) pectoral nerves
b) thoracodorsal nerve
c) axillary nerve
d) long thoracic nerve
e) dorsal scapular nerve

6) The nerve supply of serratus anterior is from the:


a) pectoral nerves
b) thoracodorsal nerve
c) axillary nerve
d) long thoracic nerve
e) dorsal scapular nerve
7) The nerve supply of pectoralis minor is from the:
a) pectoral nerves
b) thoracodorsal nerve
c) axillary nerve
d) long thoracic nerve
e) dorsal scapular nerve

8) The nerve supply to deltoid is from the:


a) pectoral nerves
b) thoracodorsal nerve
c) axillary nerve
d) long thoracic nerve
e) dorsal scapular nerve

9) Which of the following is INCORRECT? The biceps:


a) is a powerful flexor of the elbow
b) supinates the forearm
c) is paralysed by an injury to the posterior cord of the brachial plexus
d) is a weak flexor of the shoulder
e) inserts into the bicipital aponeurosis

10) Which of the following is not a direct attachment of the pectoral girdle to the trunk?
a) pectoralis minor
b) pectoralis major
c) trapezius
d) serratus anterior
e) levator scapulae

11) Which of the following does not connect the arm to the pelvic girdle?
a) deltoid
b) biceps
c) subclavius
d) subscapularis
e) supraspinatus

12) The nerve supply to supraspinatus is from the:


a) lower subscapular nerve
b) dorsal scapular nerve
c) suprascapular nerve
d) upper subscapular nerve
e) thoracodorsal nerve

13) The nerve supply to teres major is from the:


a) lower subscapular nerve
b) dorsal scapular nerve
c) suprascapular nerve
d) upper subscapular nerve
e) thoracodorsal nerve
14) Which of the following is INCORRECT, regarding branches of the posterior cord?
a) C5, 6 – upper subscapular nerve
b) C6, 7, 8 – thoracodorsal nerve
c) C5, 6 – lower subscapular nerve
d) C7, 8 – axillary
e) C5, 6, 7, 8, T1 – radial nerve

15) What is the first bone of the skeleton?


a) tibia
b) humerus
c) scapula
d) femur
e) clavicle

16) Regarding the humerus:


a) the head forms half a sphere
b) the lateral epicondyle is more prominent
c) the axillary nerve winds around the anatomical neck
d) the greater tuberosity continues distally as the medial lip of the intertubecular groove
e) the capsule of the shoulder joint extends down the medial side of the humeral shaft

17) Which muscle does not arise from the common extensor origin?
a) extensor carpi radialis brevis
b) extensor digitorum
c) extensor digiti minimi
d) extensor carpi radialis longus
e) extensor carpi ulnaris

18) Regarding the extensor retinaculum:


a) septa divide the extensor region into four compartments
b) it attaches to the ulnar styloid
c) the four extensor digitorum tendons lie deep to extensor indicis
d) it is a thickening of the deep fascia of the forearm
e) it lies transversely across the extensor surface of the wrist joint

19) Brachialis is supplied by:


a) median nerve
b) musculocutaneous nerve
c) radial nerve
d) median and musculocutaneous nn (?nerves)
e) musculocutaneous and radial nn (?nerves)

20) Which carpal bone is most commonly dislocated?


a) lunate
b) scaphoid
c) trapezium
d) capitate
e) pisiform
21) Which muscle arises from both ulnar and radius?
a) pronator teres
b) flexor carpi radialis
c) flexor digitorum superficialis
d) flexor digitorum profundus
e) flexor pollicis longus

22) Which structure is NOT attached to the pisiform?


a) abductor digiti minimi
b) ulnar collateral ligament
c) flexor carpi ulnaris
d) extensor retinaculum
e) pisometacarpal ligament

23) The median nerve goes through the heads of which muscle?
a) biceps brachii
b) supinator
c) pronator teres
d) pronator quadratus
e) flexor digitorum superficialis

24) Regarding the interosseous muscle:


a) the palmar interossei have two heads
b) there are usually four palmar interossei
c) the tendons pass on the posterior side of the deep transverse ligament
d) they insert into the extensor expansion, not the proximal phalanges
e) they are supplied by the superficial branch of the ulnar nerve (C8, T1)

25) Which nerve arises from both radius and ulna?


a) extensor pollicis longus
b) extensor pollicis brevis
c) abductor pollicis longus
d) extensor indicis
e) extensor digitorum

26) In the forearm:


a) the brachial artery lies medial to the median nerve in the cubital fossa
b) the radial artery lies lateral to the radial nerve in the middle third
c) the anterior interosseous nerve arises from the radial nerve
d) the median nerve passes between the two heads of flexor carpi ulnaris
e) the posterior interosseous nerve passes between the two layers of the supinator

27) The radial artery:


a) gives rise to the posterior interosseous artery
b) passes distally, lateral to the biceps tendon
c) passes across the tendon of abductor pollicis brevis to enter the anatomical snuffbox
d) passes over the tendon of insertion of pronator teres
e) none of the above
28) A high ulnar nerve injury might produce:
a) weakness of elbow flexion
b) a ‘claw hand’
c) weak abduction of the index finger
d) triceps paralysis
e) sensory loss over the radial three fingers

29) In the cubital fossa:


a) the floor is formed mainly by the supinator
b) the medial wall is formed by pronator teres
c) the ulnar nerve lies medially
d) the radial nerve lies medial to the biceps tendon
e) none of the above

30) Regarding the anatomical snuffbox:


a) the cephalic vein begins in the roof
b) the extensor pollicis brevis tendon forms the ulnar side
c) the trapezoid is palpable in the base
d) the cutaneous branches of the radial nerve run deep to the tendons
e) the flexor pollicis longus tendon forms the radial side

31) Pectoralis major:


a) is supplied by all three cords of brachial plexus
b) is supplied by all five segments of brachial plexus
c) is inserted into the medial lip of the bicipital groove
d) clavicular fibres are strong adductors of shoulder joint
e) the lowermost sternocostal fibres insert into the lowermost part of the humeral insertion site

32) Pectoralis major arises from all EXCEPT the:


a) lateral anterior half of manubrium
b) body of sternum
c) aponeurosis of external oblique
d) upper six ribs
e) medial half of anterior clavicle

33) Sternoclavicular joint:


a) the sternoclavicular ligament provides most joint stability
b) joint surfaces are covered by hyaline cartilage
c) the entire clavicle joint surface is in contact with manubrium
d) anterior/posterior movement occurs between manubrium and disc
e) dislocation occurs frequently

34) Long head of triceps:


a) lies between teres minor and teres major
b) is supplied by branch of radial nerve at the humeral groove
c) arises from the humerus above the radial groove
d) converges with the medial head
e) arises from the supraglenoid rim
35) Deltoid:

a) anterior fibres arise from lateral two thirds of clavicle


b) posterior fibres arise from superior lip of crest of scapular spine
c) lateral fibres only are multi-pennate
d) fibres strengthen shoulder joint capsule
e) acts in isolation to abduct humerus
Section 6

Upper limb – Answers

1E
2E
3B
4B
5E
6D
7A
8C
9C
10 B
11 C
12 C
13 A
14 D
15 E
16 E
17 D
18 D
19 E
20 A
21 C
22 B
23 C
24 C
25 C
26 E
27 D
28 C
29 B
30 A
31 B
32 D
33 D
34 A
35 C
Section 7

Upper Limb

1) The elbow joint:


a) is supplied exclusively by the radial nerve
b) permits flexion/extension and pronation/supination
c) has a capsule which attaches in part to the radius
d) communicates with the superior radioulnar joint
e) none of the above

2) With respect to the thenar muscles:


a) abductor pollicis brevis inserts into the base of the distal phalanx of the thumb
b) all arise from the flexor retinaculum
c) flexor pollicis brevis is usually supplied by a branch from the ulnar nerve
d) abductor pollicis brevis has no role in opposition of the thumb
e) opponens pollicis is the most superficial muscle of the group

3) With respect to the flexor retinaculum:


a) it attaches to the scaphoid, hamate, pisiform and trapezium
b) the tendon of palmaris longus passes deep to it
c) the median nerve passes superficial to it
d) the ulnar artery passes deep to it
e) it is pierced by the tendon of flexor carpi ulnaris

4) The medial cutaneous nerve of the arm:


a) has fibres from C8 and T1
b) arises from the dorsal cord of the brachial plexus
c) pierces the deep fascia adjacent to the tendon of biceps
d) has communications with the circumflex nerve
e) none of the above

5) Pectoralis major:
a) is synergistic to serratus anterior
b) is innervated by the median nerve
c) can abduct the arm
d) can act as an accessory muscle of respiration
e) is a lateral rotator of the arm

6) The brachial plexus:


a) arises from C6 to T1
b) lies in the anterior triangle of the neck
c) carries sympathetic fibres
d) supplies all the skin of the upper limb
e) the posterior divisions supply the flexor compartments
7) The superficial palmar arch:
a) lies level with the distal border of the outstretched thumb
b) is supplied mainly from the radial artery
c) supplies the thumb
d) lies deep to the long flexor tendons
e) arises proximal to the flexor retinaculum

8) Paralysis of which nerve results in inability to initiate abduction of the arm?


a) the axillary nerve
b) the suprascapular nerve
c) the subscapular nerve
d) the dorsal scapular nerve
e) the thoracodorsal nerve

9) The axilla:
a) communicates with the anterior triangle of the neck
b) contains lymph nodes draining the upper limb and lateral chest wall
c) has an anterior wall made up by the serratus anterior muscle
d) has an apex bounded by the humerus, clavicle and scapula
e) has no medial wall

10) Brachialis muscle:


a) is innervated by the median nerve
b) arises from the upper third of the humerus
c) is both a flexor and extensor of the elbow joint
d) attaches to the bicipital tuberosity of the radius
e) has no relation to the medial intermuscular septum

11) Simple pronation:


a) requires an intact radial nerve
b) requires an intact C8 nerve root
c) occurs without movement of the ulna
d) occurs about an axis which runs along the shaft of the radius
e) requires the action of anconeus

12) The musculocutaneous nerve:


a) supplies brachioradialis
b) terminates as the posterior interosseous nerve
c) supplies all of the brachialis muscle
d) contains fibres from C5, C6, C7 and C8
e) arises from the lateral cord of the brachial plexus

13) Which of the following lies immediately medial to the tubercle of the radius (Lister’s tubercle)?
a) extensor carpi ulnaris
b) extensor carpi radialis
c) extensor pollicis longus
d) extensor pollicis brevis
e) extensor digitorum
14) Interossei muscles in the hand:
a) flex the interphalangeal joints
b) assist in extension of metacarpophalangeal joints
c) cannot laterally deviate the middle finger
d) the palmar interossei have two heads of origin
e) are usually supplied by the ulnar nerve

15) The brachial artery:


a) commences at the upper border of teres major
b) is in direct contact with the humerus
c) has biceps tendon lying medial to it
d) is readily compressible
e) is accompanied throughout its course by the basilic vein

16) The wrist (radiocarpal) joint:


a) has a synovial cavity continuous with the inferior radioulnar joint
b) has a synovial cavity continuous with the midcarpal joint
c) permits flexion, extension, adduction and abduction, but little rotation
d) has the articular surface of the radius facing distally, medially and dorsally
e) has the flexor retinaculum anterior to it

17) The cephalic vein:


a) arises in the region of the anatomical snuffbox
b) at the elbow, is deep to the lateral cutaneous nerve of the forearm
c) terminates by joining the brachial vein
d) is medial to biceps in the arm
e) has no valves

18) The upper end of the humerus:


a) has the subscapularis attached to the greater tuberosity
b) has teres major attached to the floor of the bicipital groove
c) has three epiphyses which fuse separately with the shaft
d) has the capsular ligament of the shoulder joint attached to the whole of the anatomical neck
e) is the growing end of the humerus

19) In the antecubital fossa:


a) the ulnar nerve is on the medial side
b) the median nerve is lateral to the brachial artery
c) the radial nerve is on the lateral side
d) all the superficial veins are deep to the cutaneous nerves
e) the brachial artery is lateral to the tendon of biceps

20) The lunate articulates with all of the following EXCEPT:


a) scaphoid
b) triquetral
c) capitate
d) radius
e) trapezoid
21) The brachial artery:
a) crosses anterior to the median nerve in the arm
b) gives off the nutrient artery to the humerus
c) lies deep to biceps
d) has the ulnar nerve on its medial side
e) gives muscular branches to triceps

22) Following a laceration to the anterior surface of the wrist, a patient is unable to flex the proximal
interphalangeal joint of his middle finger when his other fingers are held in extension. The tendon of which
muscle has been divided?
a) palmaris longus
b) flexor indics
c) flexor digitorum profundus
d) flexor digitorum superficialis
e) none of the above

23) The palmar interossei:


a) abduct the fingers
b) are usually supplied by a branch of the ulnar nerve
c) have two heads
d) arise from the medial side of the metacarpal bone of the index, ring and little fingers
e) have no role in extension of the terminal phalanges

24) The cubital fossa:


a) is bounded by pronator teres, brachioradialis and the tendon of biceps
b) the brachial artery lies lateral to the radial nerve
c) has a floor made up of brachialis and supinator
d) contains the median basilic vein
e) the radial nerve lies medial to the posterior interosseous nerve

25) The capsule of the shoulder joint:


a) is supplied exclusively by the axillary nerve
b) is separated from the tendons of the short scapular muscles by a bursa
c) bridges the gap between the greater and lesser tuberosities as the transverse ligament
d) the long tendon of biceps is extracapsular
e) is the major stabilising factor for the shoulder joint

26) With respect to the carpus:


a) the intercarpal joints share one continuous synovial space
b) the intercarpal synovial space is usually continuous with the wrist
c) the proximal row consists of scaphoid, lunate and trapezium
d) the scaphoid is the only carpal bone which articulates with the radius
e) in pronation/supination, the carpus moves with the ulna
27) Compression of the median nerve in the carpal tunnel produces:
a) anaesthesia over the thenar eminence
b) wasting of the hypothenar eminence
c) loss of power of opposition of the thumb
d) anaesthesia of the little finger
e) loss of power of flexion of the thumb

28) A child has gashed the palmar aspect of her wrist on some glass. Which of the following would be
evidence of damage to her median nerve?
a) inability to flex the distal interphalangeal joint of the index finger
b) inability to flex the interphalangeal joint of the thumb
c) loss of sensation to the palmar aspect of the little finger
d) inability to oppose the thumb and little finger
e) inability to abduct the index finger

29) A 45-year-old man is unable to initiate abduction of the arm following reduction of a dislocated shoulder.
Damage to which nerve is most likely to be responsible for this condition:
a) the suprascapular nerve
b) the long thoracic nerve
c) the radial nerve
d) the infrascapular nerve
e) the axillary nerve

30) Direct attachment of the pectoral girdle to the trunk is provided by:
a) pectoralis major
b) trapezium
c) latissimus dorsi
d) subscapularis
e) deltoid

31) The posterior interosseous nerve DOES NOT supply:


a) the periosteum of the radius and ulna
b) the skin over the dorsal aspect of the thumb
c) extensor carpi ulnaris
d) extensor pollicis brevis
e) the interosseous membrane

32) The nerve supply of pectoralis minor is from the:


a) dorsal scapular nerve
b) long thoracic nerve
c) pectoral nerves
d) lower subscapular nerve
e) axillary nerve
33) The insertion of latissimus dorsi in the arm is into the:
a) lateral lip of the intertubecular groove
b) medial lip of the intertubecular groove
c) posterior border of the proximal humerus
d) floor of the intertubecular groove
e) superior facet of the greater trochanter

34) Regarding the sternoclavicular joint, the major stabilising factor is the:
a) acromioclavicular ligament
b) costoclavicular ligament
c) interclavicular ligament
d) sternoclavicular ligament
e) coracoclavicular ligament

35) The nerve supply of infraspinatus is the:


a) axillary nerve
b) long thoracic nerve
c) infrascapular nerve
d) suprascapular nerve
e) subscapular nerve

36) The cephalic vein:


a) empties into the brachial vein
b) combines with the basilic vein to form the axillary vein
c) is the continuation of the median basilic and medial cephalic veins
d) empties into the axillary vein
e) none of the above

37) Which one of the following structures pass beneath the flexor retinaculum at the wrist?
a) palmaris longus
b) ulnar nerve
c) radial artery
d) ulnar artery
e) median nerve

38) The skin of the top of the index finger is supplied by:
a) radial nerve only
b) median nerve only
c) ulnar nerve only
d) radial and ulnar nerve
e) radial and median nerve

39) Extensor pollicis longus muscle:


a) arises from the radius
b) extends the metacarpophalangeal joint of the thumb
c) is supplied by the arterial interosseous nerve
d) hooks around the dorsal tubercle of the radius (Lister’s tubercle)
e) arises proximal to the abductor pollicis longus
40) The extensor retinaculum:
a) lies transversely across the extensor surface of the wrist joint
b) is attached to the radius and the ulna
c) is attached to the pisiform
d) is attached to the scaphoid
e) is attached to the trapezium

41) The anatomical snuff box:


a) is crossed by cutaneous branches of the median nerve
b) has the anterior interosseous artery on its floor
c) contains the origin of the basilic vein
d) has extensor pollicis longus on the radial side
e) is crossed by cutaneous branches of the radial nerve

42) Compression of structures in the carpal tunnel usually results in:


a) weakness of the forearm flexors
b) weakness of flexion of the terminal phalanx of the thumb
c) weakness of the interossei muscles
d) normal sensation on the palmar surface of the little finger
e) weakness of the lumbrical muscles

43) Holding a heavy hammer in your hand involves:


a) only the long flexors of the fingers
b) flexion of wrist to strengthen grip
c) immobilisation of the shoulder joint to strengthen grip
d) only the long flexors of fingers and opposition of the thumb
e) requires synergic contraction of wrist extensors

44) The anatomical snuff box:


a) has the tendon of extensor pollicis brevis on its ulnar side
b) has the radial artery lying in its floor
c) has the radial styloid process as the only palpable bony point
d) has the tendon of abductor pollicis brevis on its radial side
e) contains the origin of the basilic vein

45) Rotator cuff muscles include:


a) subclavius
b) teres minor
c) pectoralis major
d) teres major
e) deltoid

46) Regarding synovial flexor sheaths in the hand and wrist, which one of the following is INCORRECT?
a) they surround flexor tendons in the carpal tunnel
b) the superficial and deep flexors are invested with a common synovial sheath
c) the common flexor sheaths can communicate with flexor pollicis longus sheath in some people
d) for the index, ring and middle finger, a separate synovial sheath lines the fibrous sheath over the
phalanges
e) the sheath is the origin of the lumbricals
47) Which of the following structures is NOT one of the contents of the cubital fossa?
a) brachial artery
b) tendon of biceps brachii
c) radial nerve
d) anterior interosseous nerve
e) median nerve

48) The superficial branch of the ulnar nerve supplies:


a) palmaris brevis
b) flexor digitorum ulnaris
c) palmar aspect index finger
d) opponens pollicis
e) thenar eminence

49) The order of tendons in the extensor compartment of the distal forearm from radial to ulnar sides is:
ED = extensor digitorum
ECRB = extensor carpi radialis brevis
FCU = flexor carpi ulnaris
EI = extensor indicis
ECRL = extensor carpi radialis longus
ECU = extensor carpi ulnaris
EPL = extensor pollicis longus

a) ECRB; ECRL; EPL; ED; FCU; ECU; EI


b) ECRB; ECRL; EPL; ED; ECU; FCU; EI
c) ECRL; ECRB; EPL; ED; ECU; EI; FCU
d) ECRL; ECRB; EPL; ED & EI; ECU; FCU
e) ECRB; ECRL; EPL; ECU; FCU; ED & EI

50) Which of the following is true about flexor digitorum superficialis?


a) origin forms upper limit of the space of parona
b) all four tendons lie on the same plane under flexor retinaculum
c) is innervated by median and ulnar nerves
d) tendon to index finger separates before other three tendons high in forearm
e) median nerve passes between its two heads

51) Which of the following statements about the brachial plexus is INCORRECT?
a) long thoracic nerve arises from roots
b) Erb’s palsy occurs following traction to upper roots and trunk
c) posterior cord has five branches
d) suprascapular nerve arises from trunks
e) trunks lie behind clavicle on first rib

52) Branches of the axillary artery DO NOT include:


a) superior thoracic
b) subscapular
c) medial thoracic
d) thoracoacromial
e) posterior circumflex humeral
53) Which of the following is NOT TRUE regarding the breast?
a) it arises from the midline to mid axillary line from the second to the sixth ribs
b) it is subcutaneous
c) blood supply is mainly from the lateral thoracic and internal thoracic artery
d) most lymph drains to the axillae
e) it is invested in a thick fibrous capsule

54) Biceps:
a) long head arises from infraglenoid tubercle
b) is supplied by a branch of the medial cord of the brachial plexus
c) the two bellies do not merge
d) is a pronator of the forearm
e) short head arises from coracoid process, lateral to coracobrachialis

55) The radial nerve:


a) supplies extensors to the elbow
b) pierces the medial intermuscular septum of the mid arm
c) supplies extensor carpi ulnaris
d) runs on the lateral side of the radial artery in the forearm
e) runs in the cubital fossa

56) Which of the following DOES NOT form one of the boundaries of the cubital fossa?
a) brachialis
b) supinator
c) line connections the two humeral epicondyles
d) bicipital aponeurosis
e) medial margin of pronator teres

57) Which of the following muscles DOES NOT arise from the common extensor origin?
a) extensor carpi radialis brevis
b) extensor digitorum comminus
c) extensor carpi radialis longus
d) extensor digiti minimi
e) extensor carpi ulnaris

58) Regarding the shoulder joint:


a) glenoid labrum is a ring of hyaline cartilage
b) subacromial bursa communicates with joint
c) capsule attaches only around the articular margin
d) subscapular bursa communicates with joint
e) supraspinatus is a medial rotator of humerus

59) Which of the following is CORRECT?


a) the suprascapular nerve arises from the posterior aspect of C5
b) the five roots emerge between scalenus anterior and scalenus medius to form the trunks
c) the thoracodorsal nerve arises from the posterior aspect of C5
d) the axillary nerve passes through the triangular space to lie in contact with the surgical neck of humerus
e) the median nerve is the largest branch of the whole plexus
60) The quadrangular space between teres major and subscapularis transmits:
a) lower subscapular nerve
b) axillary artery
c) profunda brachii vessels
d) radial nerve
e) post circumflex humeral artery

61) With regard to the elbow joint, which is NOT TRUE?


a) it communicates with the radioulnar joint
b) the carrying angle is mostly determined by the obliquity of the ridge between coronoid and olecranon
prominences
c) the radial collateral, ulnar collateral and annular ligaments keep the bones together
d) the carrying angle is partly determined by the bow in the ulnar and radial shafts
e) it is supplied by the brachial nerve

62) Which of the following DOES NOT arise from the roots of the brachial plexus?
a) dorsal scapular
b) nerve to serratus anterior
c) medial pectoral nerve
d) nerve to subclavius

63) Regarding the hand:


a) deep palmar arch is level with the distal border of the outstretched thumb web
b) the superficial branch of the ulnar nerve supplies the hypothenar muscles
c) deep branch of the ulnar nerve lies within the concavity of the deep palmar arch
d) flexor digitorum superficialis tendon inserts into the base of the distal pharynx
e) lumbricals insert into the extensor expansion and proximal phalanges

64) The venous systems that contribute least to venous drainage of the forearm is:
a) the basilic vein
b) the cephalic vein
c) the deep veins which are often duplicate
d) the carpal rete
e) the median cubital

65) Which of the following IS NOT true about the flexor carpi ulnaris?
a) acts as a synergist during wrist extension
b) ulnar artery passes deep to its deep head
c) inserts into base of fifth metacarpal
d) most medial muscles arising from the common flexor origin
e) ulnar nerve passes between its two heads

66) Which of the following structures DOES NOT pierce the clavipectoral fascia in the delto-pectoral triangle?
a) lymphatics
b) medial pectoral nerve
c) acromiothoracic axis
d) lateral pectoral nerve
e) cephalic vein
67) Radial nerve:
a) is the largest branch of the brachial plexus
b) occupies the length of the spiral groove
c) damage causes inability to extend the wrist and the interphalangeal joints
d) damage causes sensory loss to the palm
e) arises from the lateral cord of the brachial plexus

68) Regarding the shoulder joint:


a) the glenoid labrum is the most important stabilising factor
b) the strong capsule is reinforced by tight glenohumeral ligaments
c) the coracoacromial arch prevents the humeral head from displacing
d) the long head of triceps gives stability to the abducted humerus
e) the pull of teres minor stabilises the abducted humerus

69) The articulating surfaces of which of the following synovial joints are covered by fibrocartilage?
a) scapholunate joint
b) glenohumeral joint
c) acromioclavicular joint
d) manubriosternal joint
e) sternocostal joint

70) A structure that does not lie in the cubital fossa is:
a) brachial artery
b) median nerve
c) median cubital vein
d) superficial radial artery
e) radial nerve if brachioradialis is lateralised

71) Which of the following is CORRECT concerning flexor digitorum profundus?


a) it arises from both radius and ulna
b) is innervated by both median and ulnar nerves
c) the origins of the lumbricals arise from its tendons
d) it flexes the terminal phalangeal joints

72) Which of the following groups of lymph nodes directly drain the breast?
a) lateral axillary nodes
b) subscapular nodes
c) pectoral nodes
d) parasternal nodes
e) infraclavicular nodes

73) Which of the following IS NOT true about pectoralis major?


a) only upper limb muscle supplied by all five segments of brachial plexus
b) arises by two heads
c) inserts via a bilaminar tendon
d) innervated by lateral pectoral nerve
e) contributes to boundaries of axilla
74) Axillary artery:
a) becomes brachial artery at lower border teres minor
b) axillary vein lies laterally to the artery
c) is divided into three parts by pectoralis minor
d) second part is clasped by the two heads of median nerve
e) gives off the superior thoracic artery from its second part

75) Regarding flexor digitorum profundus, which is NOT TRUE?


a) is the most powerful and bulky muscle of the forearm
b) arises from the common flexor origin
c) the tendon for the index separates in the forearm from the three other tendons
d) it gives rise to origin of four lumbricals
e) it is supplied by the anterior interosseous nerve and the ulnar nerve in a variable distribution

76) Damage to the median nerve may be suggested clinically by:


a) a wasting of the interossei
b) pointing index finger
c) ‘claw hand’
d) sensory loss over ulnar side of hand
e) inability to abduct the index finger

77) Which of the following DOES NOT form the boundaries of the cubital fossa:
a) anconeus
b) brachioradialis
c) pronator teres
d) deep fascia of the forearm
e) bicipital aponeurosis

78) Which of the following is NOT TRUE concerning the elbow joint?
a) it is a synovial joint
b) the capsule of the synovial joint is attached to the radius distal to the annular ligament
c) the humeroulnar joint space communicates with the radioulnar joint space
d) the joint is supplied by musculocutaneous, median, radial and ulnar nerves

79) Which of the following statements about the glenohumeral (shoulder joint) is INCORRECT?
a) long tendon of biceps is extrasynovial
b) subscapularis bursa communicates with joint cavity
c) innervated by medial pectoral nerve
d) branches of third part of axillary artery provide majority of blood supply
e) surface area of humeral head is about four times greater than that of glenoid fossa

80) Which of the following structures IS NOT one of the contents of the carpal tunnel?
a) flexor digitorum superficialis
b) ulnar artery
c) flexor digitorum profundus
d) median nerve
e) flexor pollicis longus
81) Which of the following IS NOT true about pronator teres?
a) ulnar artery passes between two heads
b) forms medial boundary of cubital fossa
c) arises from common flexor origin
d) adducts radius
e) less powerful pronator than pronator quadratus

82) Which of the following statements about the cubital (elbow) joint is INCORRECT?
a) innervated by branch of musculocutaneous nerve to brachialis
b) “closed-packed” position is in extension
c) it is a compound synovial joint
d) radial collateral ligament consists of three separate bands
e) carrying-angle is about 160-170°

83) Which of the following is CORRECT about the latissimus dorsi?


a) arises from all spinous processes from T8 and S5
b) known as the “boxers muscle”
c) innervated by the long thoracic nerve
d) derivative of upper limb myotomes
e) forms the superior border of the triangle of auscultation

84) Which of the following is CORRECT about flexor carpi radialis?


a) tendon receives muscle fibres down to just above the wrist
b) tendon lies in a groove on the trapezoid
c) arises lateral to flexor digitorum superficialis
d) has median nerve ‘plastered’ to deep surface
e) tendon pierces flexor retinaculum

85) Which of the following pierce the medial intermuscular septum of the arm?
a) medial cutaneous nerve of the arm
b) ulnar nerve
c) median nerve
d) basilic nerve
e) profunda brachii artery

86) Which of the following DOES NOT arise, in part, from the lateral intermuscular septum of the arm?
a) brachioradialis
b) extensor carpi radialis longus
c) brachials
d) medial head of triceps brachii
e) none of the above arise from the lateral intermuscular septum of the arm

87) Which of the following DOES NOT contribute to the innervation of the elbow joint?
a) radial nerve
b) ulnar nerve
c) median nerve
d) musculocutaneous nerve
e) medial cutaneous nerve of the arm
88) Regarding the axilla:
a) the posterior wall consists of subscapularis and teres minor
b) the medial wall is formed by serratus anterior down to the 6th intercostal space
c) the apex communicates directly with the posterior triangle of the neck
d) coracobrachialis forms part of the anterior wall
e) the axillary artery is generally described as having eight branches

89) The largest branch of the axillary artery is:


a) superior thoracic artery
b) thoracoacromial artery
c) lateral thoracic artery
d) subscapular artery
e) posterior circumflex humeral artery

90) The cubital fossa has:


a) a floor formed by the deep fascia of the forearm
b) the median cephalic vein lying medially on its roof
c) the brachial artery medial to the tendon of the biceps
d) supinator forming part of its lateral wall
e) flexor carpi radialis longus forming its lateral wall

91) The only carpal bone to give attached to both flexor and extensor retinacula is:
a) scaphoid
b) trapezoid
c) hamate
d) triquetral
e) pisiform

92) In the carpal tunnel:


a) the individual tendons arising from flexor digitorum profundus are all fused, and do not separate until
they reach the palm
b) the synovial sheath of flexor digitorum superficialis arises from the ulna bursa, but the sheath of
profundus does not
c) the tendon for the index finger from flexor digitorum superficialis lies medial to the median nerve
d) flexor carpi radialis and flexor pollicis longus tendons share a synovial sheath
e) the tendon of flexor digitorum superficialis to the middle finger lies deep to the tendons to the little
finger

93) Structures in the anatomical snuff box include all the following EXCEPT:
a) the radial tubercle
b) the scaphoid
c) the base of the thumb metacarpal
d) the trapezium
e) the radial artery
94) Which muscle arises in part from the scaphoid tubercle?
a) flexor pollicis brevis
b) abductor pollicis brevis
c) opponens pollicis
d) adductor pollicis
e) first palmar interossei

95) Which of the following muscles arises, in part, from the radial collateral ligament of the elbow joint?
a) extensor carpi radialis brevis
b) supinator
c) extensor digiti minimi
d) extensor carpi ulnaris
e) extensor digitorum

96) Which nerve is a branch of the lateral cord of the brachial plexus?
a) upper subscapular nerve
b) thoracodorsal nerve
c) musculocutaneous nerve
d) ulnar nerve
e) lower subscapular nerve

97) The peripheral nerve arising directly from the upper trunk of the brachial plexus is the:
a) dorsal scapular
b) thoracodorsal
c) suprascapular
d) upper subscapular
e) lower subscapular

98) The first part of the subclavian artery:


a) usually gives off no branches
b) lies behind the anterior scalene muscle
c) makes a groove in the dome of the pleura
d) is encircled by the ansa cervicalis
e) on the left lies anterior to the common carotid artery
Section 7

Upper Limb – Answers

1 D 34 B 67 A
2 B 35 D 68 D
3 A 36 D 69 C
4 A 37 E 70 C
5 D 38 B 71 A
6 C 39 D 72 A
7 A 40 C 73 C
8 B 41 E 74 C
9 B 42 D 75 B
10 C 43 E 76 B
11 C 44 B 77 A
12 E 45 B 78 B
13 C 46 E 79 C
14 E 47 D 80 B
15 D 48 A 81 A
16 C 49 D 82 D
17 A 50 A 83 D
18 E 51 E 84 E
19 C 52 C 85 B
20 E 53 E 86 C
21 B 54 E 87 E
22 D 55 D 88 C
23 B 56 E 89 D
24 C 57 C 90 C
25 C 58 D 91 E
26 A 59 B 92 C
27 C 60 E 93 A
28 D 61 E 94 B
29 A 62 C 95 B
30 B 63 C 96 C
31 B 64 C 97 C
32 C 65 B 98 C
33 D 66 B
Section 1

Head and Neck mcqs

1) Regarding the superior orbital fissure, which is INCORRECT?


a) its common tendinous ring binds the SOF content of nerves and muscles to the contents of the optic
canal
b) the origin of levator palpebrae superioris is its bony upper margin
c) lacrimal, frontal and trochlear nerves pass through it
d) the oculomotor, abducens and nasociliary nerves lie within the cone of the extraocular muscles

2) Regarding the extraocular muscles:


a) they all arise from a common tendinous ring around the superior orbital fissure
b) the rectus muscles all pass laterally to their point of insertion because of the angle of the orbital apex
within the skull
c) the superior oblique muscle passes through the trochlear, a fibrocartilage loop attached to the frontal
bone lateral margin, just behind the orbital margin
d) except for superior oblique, all nerve supply to muscles enter from their optic side

3) With regards to eye movement, which is INCORRECT?


a) the medial and lateral rectus evoke simple horizontal movement only
b) the inferior oblique turns the eye down and out
c) the superior rectus turns the eye up and in
d) the inferior rectors and superior oblique together produce vertical down gaze

4) Which is INCORRECT?
a) in a 4th cranial nerve paralysis, the affected eye lies slightly inturned
b) in a 6th cranial nerve palsy, the lateral rectus is affected
c) in a 3rd nerve palsy, levator palpebrae is affected
d) in an oculomotor nerve palsy the eye looks down and out

5) With regards to the retina, which is CORRECT?


a) the retina covers the inner surface of the choroids and is light sensitive everywhere except at the
corneal area
b) the optic disc contains retina that is completely free of blood vessels and is yellowish in colour
c) the optic disc and fovea are of similar size
d) the fovea contains no blood vessels or cones, but a high concentration or rods

6) The nasal septum consists of:


a) the maxilla
b) the vomer and ethmoid bones
c) the sphenoid and ethmoid bones
d) the frontal, zygoma and maxilla
e) the vomer and palatine bones
7) The ophthalmic artery:
a) is a branch of the ECA
b) enters through the superior orbital fissure
c) does not penetrate the meninges of the optic nerve
d) forms an anastomoses between ECA and ICA
e) is an end artery

8) Regarding the carotid sheath:


a) arisa cervicalis lies behind the IJV
b) is free to move in the neck
c) contains the vagus and phrenic ????
d) the sympathetic trunk lies outside the sheath
e) the CCA lies lateral to the IJV

9) The contents of the jugular foramen include:


a) superior petrosal sinus
b) internal jugular vein
c) vagus nerve
d) hypoglossal nerve
e) all of the above

10) The sensory innervation of the auricle of the ear includes:


a) auricolotermporal nerve (V3)
b) great auricular nerve (C2)
c) facial nerve via tympanic plexus (VII)
d) auricular branch of vagus (X)
e) all of the above

11) Regarding the abducent nerve (CN V1):


a) the nucleus lies in the medulla
b) supplies superior oblique muscle
c) enters the orbit ???? superior orbital fissure
d) has no relation to the cavernous sinus
e) carries autonomic fibres from Edinger-Westphal node

12) Regarding the face, which is INCORRECT?


a) there is no deep fascia on the face
b) the bulk of orbicularis oris muscle comes from buccinator
c) the eyelid muscles are completely supplied by CNVII
d) the parotid duct pierces buccinator opposite the third upper molar tooth
e) the facial nerve supplies the occipital belly of occipitofrontalis

13) Regarding the trigeminal nerve:


a) branches emerge from the parotid gland
b) the mandibular nerve has three cutaneous branches
c) the supratrochlear nerve supplies midline forehead and scalp
d) the infratrochlear nerve is a branch of the maxillary nerve
e) the bridge of the nose is supplied by the external nasal nerve
14) Which structure does NOT pass through the parotid gland?
a) retromandibular vein
b) temporozygomatic branch of facial nerve
c) cervicofacial branch of facial nerve
d) internal jugular vein
e) external carotid artery

15) Which structure is NOT in the carotid sheath?


a) internal jugular vein
b) hypoglossal nerve
c) glossopharyngeal nerve
d) external jugular vein
e) internal carotid artery

16) Which is an intrinsic muscle of the tongue?


a) superior longitudinal muscle
b) genioglossus muscle
c) hyoglossus muscle
d) styloglossus muscle
e) palatoglossus muscle

17) Which muscle abducts the vocal cords?


a) cricothyroid
b) oblique arytenoid
c) posterior cricoarytenoid
d) lateral cricoarytenoid
e) thyroepiglottic

18) Which laryngeal muscle is NOT supplied by the recurrent laryngeal nerve?
a) thyroarytenoid
b) cricothyroid
c) aryepiglottic
d) oblique arytenoid
e) posterior cricoarytenoid

19) The internal laryngeal nerve supplies:


a) sensation to the vocal folds
b) cricothyroid muscle
c) sensation above the vocal folds
d) transverse arytenoid muscle
e) sensation below the vocal folds

20) Which nerve does NOT supply skin to the upper eyelid?
a) lacrimal
b) supraorbital
c) supratrochlear
d) infratrochlear
e) infraorbital
21) Which extraocular muscle does NOT arise from the tendinous ring of the orbit?
a) superior rectus
b) superior oblique
c) inferior rectus
d) medial rectus
e) lateral rectus

22) Which structure passes through the tendinous ring of the orbit?
a) ophthalmic artery
b) inferior rectus muscle
c) lacrimal nerve
d) trochlear nerve
e) superior oblique muscle

23) Which bone is not part of the medial wall of the orbit?
a) maxilla
b) lacrimal bone
c) sphenoid
d) palatine bone
e) ethmoid

24) Which muscle helps to open the jaw?


a) medial pterygoid
b) lateral pterygoid
c) masseter
d) temporalis
e) buccinator

25) Regarding the vertebral column:


a) ligamentum flava attach adjacent pedicles
b) lumbar vertebrae have foramen in their transverse process
c) the intervertebral disc is a primary cartilaginous joint
d) rotation is greatest in the thoracic region
e) the cruciform ligament holds the dens in place

26) The middle meningeal artery is a branch of the:


a) internal carotid artery
b) middle cerebral artery
c) maxillary artery
d) deep temporal artery
e) facial artery

27) They hyoid bone is at what level?


a) C2 vertebra
b) C3 vertebra
c) C4 vertebra
d) C5 vertebra
e) C6 vertebra
Section 1
Head and Neck – Answers

1 A
2 D
3 B
4 A
5 C
6 B
7 D
8 D
9 C
10 E
11 C
12 C
13 B
14 D
15 D
16 A
17 C
18 B
19 C
20 E
21 B
22 A
23 D
24 B
25 E
26 C
27 B
Section 2
Face, Blood Supply, Nerves etc

1) The parotid gland:


a) is the largest of the major salivary glands
b) is a mainly mucons gland
c) is a well organised, regular gland, clearly divided into lobes
d) drains into the parotid duct on its posteromedial surface
e) extends from the zygomatic arch to the lower level of the earlobe

2) Cutaneous sensation to the upper lip is supplied by the:


a) zygomaticofacial nerve
b) buccal nerve
c) infraorbital nerve
d) mental nerve
e) external nasal nerve

3) Skin over the upper lateral eyelid is supplied by the:


a) lacrimal nerve
b) supraorbital nerve
c) supratrochlear nerve
d) zygomaticofacial nerve
e) zygomaticotemporal nerve

4) The facial nerve:


a) marginal mandibular branch supplies muscles of the upper and lower lips
b) emerges through the stylomastoid foramen
c) has four main branches that exit the parotid gland
d) supplies the anterior belly of digastric
e) divides into temporofacial and cervicofacial divisions just after it enters the parotid gland

5) The facial artery:


a) is a branch of the internal carotid artery
b) crosses the angle of the jaw at the posterior border of masseter muscle
c) courses along inferior margin of parotid duct
d) lies in front of the facial vein
e) none of the above
Section 2

Face, Blood Supply, Nerves etc – Answers

1 A
2 C
3 A
4 B
5 D
Section 3

Head / Neck / CNS

1) The cervical sympathetic trunk:


a) lies anterior to scalenus anterior
b) is enclosed in the carotid sheath
c) is lateral to the vertebral artery
d) each ganglion gives off a cardiac branch
e) disruption causes meiosis, ptosis and increased sweating

2) The oculomotor nerve:


a) does not enter the cavernous sinus
b) supplies the ciliary muscle
c) emerges from the pons
d) contains sympathetic fibres from the Edinger-Westphal nucleus
e) does not pass through the tendinous ring

3) The chorda tympani carries:


a) taste fibres for the posterior third of the tongue
b) ordinary sensation for the anterior two thirds of the tongue
c) taste fibres for the anterior two thirds of the tongue
d) cervical sympathetic fibres
e) motor fibres to the muscles of mastication

4) Which is NOT a branch of the facial nerve?


a) nerve to stapedius
b) chorda tympani
c) nerve to levator angili oris
d) greater superficial petrosal nerve
e) auriculotemporal nerve

5) Regarding lymph drainage of head and neck, which is INCORRECT?


a) superficial cervical nodes lie along the external jugular veins
b) submandibular nodes are lateral to submental nodes
c) the left jugular lymph trunk usually drains into the thoracic duct
d) the jugulodigastric nodes lie on/near the tendon of omohyoid
e) preauricular nodes are outside and within the capsule of the parotid gland

6) The middle meningeal artery is a branch of the:


a) middle cerebral artery
b) anterior cerebral artery
c) internal carotid artery
d) maxillary artery
e) superficial temporal artery
7) Which is NOT a content of the posterior triangle of the neck?
a) subclavian artery
b) lymph nodes
c) transverse cervical vein
d) omohyoid muscle
e) sternocleidomastoid muscle

8) Which laryngeal muscle abducts the vocal cords?


a) posterior cricoarytenoid
b) cricothyroid
c) transverse arytenoid
d) vocalis
e) thyroarytenoid

Section 3

Head and Neck – Answers

1 D
2 B
3 C
4 E
5 D
6 D
7 E
8 A
Section 4

Head and Neck Anatomy

1) Regarding the bones of the skull:


a) the middle cranial fossa does not extend to the posterior cranial vault
b) the temporal lobe rests on the bony rather than the membranous part of the middle cranial fossa
c) the posterior cranial fossa contains the cerebella and lies superior to the tentorium cerebelli
d) the floor of the anterior cranial fossa is formed from the orbital plate of the parietal bone
e) the cribriform plate lies in the midline and is formed from the roof of the sphenoid bone

2) Regarding the bones of the skull:


a) the anterior clinoid processes are formed by the lesser wings of the sphenoid
b) the posterior clinoid processes are formed from the occipital bone
c) the dorsum sellae is formed from the anterior part of the occipital bone
d) the petious temporal bone forms the floor of the middle cranial fossa, but not the wall of the posterior
cranial fossa
e) the inferior orbital fissure separates the lesser and greater wings of the sphenoid

3) Regarding the cervical spine:


a) all seven cervical vertebrae have spinous processes
b) rotatory movements of the head occur mostly at the atlanto-occipital joints
c) the odontoid process (peg) is encased by a bony canal in the axis
d) all seven cervical vertebrae have foramina transversaria for the vertebral artery to pass through it
e) spinous processes, where present, are all bifid except for C7

4) Regarding the triangles of the neck:


a) the posterior triangle is bound by trapezius, sternocleidomastoid and the middle quarter of clavicle
b) the anterior triangle is further divided into two smaller triangles, the carotid and submandibular
triangles
c) the posterior belly of digastric (and stylohyoid) separates the carotid and submandibular triangles
d) the accessory nerve (CNXI) divides the posterior triangle into approximately two halves, and of these
the lower contains little of importance
e) the investing fascia splits to enclose the sternomastoid and trapezius, but the parotia and
submandibular glands lie deep to the fascia, in the anterior triangle

5) Regarding anatomy of the neck, landmarks:


a) the arch of the cricoid cartilage is palpable as it protrudes forward of the trachea
b) the cricoid cartilage marks the level of C5
c) the transverse process of the axis is the most prominent of the cervical transverse processes, and is
palpable between angle of mandible and mastoid
d) the body of hyoid is not palpable because it is hidden behind the thyroid cartilage
e) the coracoid process of scapula is palpable within the deltopectoral triangle
6) Regarding fascia and sheaths in the neck:
a) the pretracheal fascia contains both trachea and oesophagus, and also splits to envelop the lobes of the
thyroid gland
b) the prevertebral fascia encloses vertebrae and muscles acting on the vertebrae, but does not contribute
to the investment over the brachial plexus as it passes between scalene muscles
c) the investing fascia encloses trapezius sternomastoid and platysma muscles
d) the structures contained within the carotid sheath include carotid artery, sympathetic chain and jugular
vein, but not phrenic nerve or vagus
e) infection may track in the pretracheal space to mediastinum

7) For sternocleidomastoid, which is TRUE?


a) contraction of one muscle rotates the head to the ipsilateral shoulder
b) it is crossed superficially by the external jugular vein
c) it is supplied by the transverse cervical nerve
d) its clavicular fibres mainly insert into the superior nucal line
e) it is superficial to the deep cervical fascia

8) Which is not considered a content of the posterior triangle of the neck?


a) subclavian artery
b) trunks of the brachial plexus
c) internal jugular vein
d) branches of the cervical plexus
e) accessory nerve

9) For the thyroid, which is TRUE?


a) the thyroid isthmus crosses the thyroid cartilage
b) the superior thyroid arteries are branches off the internal carotid arteries
c) the posterior surface lies on the carotid sheaths
d) the inferior thyroid arteries are branches off the external carotid arteries
e) the recurrent laryngeal nerves pass anteriorly to each lateral lobe

10) For the great neck vessels, which is TRUE?


a) the carotid sheath contains the ansor cervicalis, vagus and recurrent laryngeal nerves
b) the external carotid artery has three branches
c) the internal carotid artery has six branches
d) the internal jugular vein lies lateral to the carotid artery throughout its course
e) the carotid sinus lies at the commencement of the common carotid artery

Head and Neck Anatomy – Answers


1 B
2 A
3 E
4 C
5 A
6 A
7 B
8 C
9 C
10 D
1. The blood supply of Little’s area (anteroinferior part of the septum) is best described by
a. Anterior and posterior ethmoidal arteries from the ophthalmic artery
b. The sphenopalatine branch of the maxillary artery
c. Sphenopalatine artery and septal branch of the superior labial branch of the facial artery
d. All of the above
e. None of the above

2. the septum of the nasal cavity is innervated by


a. nasopalatine nerve from cranial nerve V2
b. posterior ethmoidal nerve from V1
c. greater palatine nerve from V2
d. lesser palatine nerve from V2
e. none of the above

3. The posterior cricoarytenoid muscles


a. Abduct the vocal cords
b. Adduct the vocal cords
c. Tensor of the vocal cords
d. Relaxors of the vocal cords
e. Act as a sphincter

4. The superior laryngeal nerve


a. Divides into internal and recurrent laryngeal nerves
b. Supplies the crocothyroid muscle via an external laryngeal branch
c. Supplies all the intrinsic muscles of the larynx
d. Is sensory to larynx below the vocal cords
e. None of the above

5. The surface markings of the trachea include


a. Origin at lower end of the cricoid at C4 vertebra
b. Origin at C6 vertebra level
c. Termination at T2 at expiration
d. Termination at T4 level at maximal inspiration
e. 3rd to 5th rings covered anteriorly by isthmus of the thyroid

6. What runs through the foramen spinosum?


a. Internal carotid artery
b. Maxillary branch of the trigeminal nerve
c. Mandibular branch of the trigeminal nerve
d. Middle meningeal artery
e. Meningeal nerve

7. The internal jugular vein


a. Drains into the subclavian vein on the left
b. Lies in the carotid sheath with the carotid artery and the sympathetic trunk
c. Lies lateral to the internal carotid artery at the base of the skull
d. Lies lateral to the carotid artery in the lower neck
e. Lies anterior to the sternocleidomastoid
8. The seventh cervical vertebra
a. Is typical
b. Has a bifid spinous process
c. Transmits the vertebral artery through the foramen in the transverse process
d. Has the supra-pleural membrane attached to the anterior tubercle
e. Has a short spinous process

9. The atlas
a. Has no foramen in the transverse process
b. Is the narrowest cervical vertebra
c. Has a body
d. Has a posterior arch grooved by the vertebral artery
e. Has a short spinous process

10. Branches of the carotid artery include


a. Inferior thyroid artery
b. Ascending pharyngeal artery
c. Internal thoracic
d. Superficial cervical
e. Thymic artery

11. The blood supply to the nasal cavity


a. Is only from the external carotid
b. Mainly enters through the nostril
c. Does not communicate with intracranial vessels
d. Mainly enters the sphenopalatine foramen
e. Arrives to Little’s area from ophthalmic artery branches

12. Protection of the airway during swallowing is not facilitated by


a. The sphincteric action of the ariepiglottic muscles
b. closure of the glottis
c. Elevation of the larynx
d. Contraction of the cricothyroid muscle
e. Posterior bulging of the tongue assisting closure of the larynx

13. Structure of the larynx includes


a. The inlet being bounded posteriorly by the epiglottis
b. The posterior cricoarytenoid being an adductor of the vocal cords
c. The aryepiglottic fold contains the cuneiform cartilage
d. The rima of the vestibule being the fissure between the two vocal cords
e. The cricoid cartilage not being circumferential

14. The trachea


a. Commences below the cricoid at the level of C5
b. Enters the thoracic inlet slightly to the left
c. Is marked at its lower end by the level of the sternal angle
d. Is supplied by the glossopharyngeal nerve
e. Drains to axillary lymph nodes
15. All of the following are branches of the external carotid artery EXCEPT:
a. Superior thyroid artery
b. Hypoglossal artery
c. Facial artery
d. Lingual artery
e. Ascending pharyngeal artery

16. Regarding triangles of the neck all of the following structures are boundaries of the triangle named EXCEPT:
a. Submental triangle, mandible
b. Anterior triangle, mandible
c. Digastric triangle, mandible
d. Carotid triangle, sternocleidomastoid
e. Anterior triangle, sternocleidomastoid

17. All of the following are contents of the posterior triangle of the neck EXCEPT:
a. Occipital lymph nodes
b. Accessory nerve
c. Cervical plexus
d. Inferior belly of omohyoid
e. Transverse cervical vessels

18. Which one of the following opens into the inferior meatus of the nose
a. Frontal sinus
b. Ethmoidal sinus
c. Maxillary sinus
d. Nasolacrimal duct
e. Auditory tube

19. A freacture through the roof of the maxillary sinus might result in sensory loss to the
a. Tympanic membrane
b. Lacrimal gland
c. Upper molar teeth
d. Skin overlying the zygomatic bone
e. Upper incisors and canine teeth

20. All of the following structures pass through the jugular foramen EXCEPT:
a. Jugular vein
b. Glossopharyngeal nerve
c. Hypoglossal nerve
d. Accessory nerve
e. Vagus nerve

21. Regarding the basilar artery, all the below are true EXCEPT:
a. Gives off branches to the anterior spinal artery
b. Divides to give off both posterior cerebral arteries
c. Supplies branches to the pons
d. Formed by the union of the vertebral arteries
e. Lies on the ventral aspect of the cerebral peduncle
22. In the circle of Willis
a. The basilar artery divides into right and left posterior cerebellar arteries
b. The middle cerebral arteries branch off and supply the motor but not sensory cortex
c. The anterior communicating artery unites the middle cerebral artery to the internal cerebral artery
d. It encircles the inferior brainstem at C2-3 level
e. The internal carotid artery gives off the ophthalmic artery before dividing into anterior and middle cerebral
arteries

23. Regarding the facial vein, all of the following are true EXCEPT:
a. It drains into the internal jugular vein
b. It has no valves
c. It communicates with the cavernous sinus via the ophthalmic vein
d. It runs inferoposteriorly anterior to the facial artery
e. It communicates with the pterygoid plexus via the deep facial vein

24. The 2nd cervical vertebra


a. Has a very small spinous process
b. Articulates with the occiput
c. Has a bifid spinous process
d. It referred to as the atlas
e. Has a dens that occupies the posterior 1/3 of the canal

25. Regarding the larynx


a. All muscles are supplied by the recurrent laryngeal nerve
b. Thyroarytenoid muscle alters the tension of the vocal cord
c. Recurrent laryngeal nerve passes anterior to the criocthyroid joint
d. During swallowing, the epiglottis acts as a passive flap
e. All of the larynx is covered by pseudostratified columnar epithelium

26. Regarding the vertebral column all are correct EXCEPT:


a. The facet joints in the lumbar spine lie in an anteroposterior plane
b. The vertebral arteries ascend through the foramen in the transverse processes of the upper six cervical
vertebrae
c. The spinous processes of the cervical vertebrae are usually bifid
d. Thoracic vertebrae I, II and XII have single costal facets on their pedicles
e. The sacrum has 5 sets of anterior and posterior sacral foramina, one corresponding to each of the sacral
segments

27. The internal jugular vein


a. Is surrounded by the thickest portion of carotid sheath
b. Receives drainage from all the parathyroid glands
c. Is crossed posteriorly by the accessory nerve
d. Is crossed anteriorly by the thoracic duct
e. Contains valves within its lumen
28. Venous drainage of the face
a. Is both deep and superficial
b. Empties ultimately into the internal jugular vein alone
c. Communicates indirectly with the cavernous sinus via the deep facial vein
d. Communicates directly with the cavernous sinus via the supraorbital veins
e. All of the above

29. The larynx


a. Is a respiratory organ whose essential function is phonation
b. Extends from the anterior upper border of the epiglottis to the level of C6
c. Consists of two single cartilages, the thyroid and cricoid
d. Is hauled up beneath the tongue with the epiglottis tilted anterior and upwards during swallowing
e. Is supplied by the external laryngeal nerve except for the cricothyroid muscle which is supplied by the
recurrent laryngeal nerve

30. Regarding the larynx


a. The external laryngeal nerve supplies the posterior cricoarytenoid muscle
b. The internal laryngeal nerve supplies cricothyroid
c. The blood supply above the vocal cords is by a branch of the internal carotid
d. Normal vocal cords are always covered by stratified squamous epithelium
e. The recurrent laryngeal nerve lies immediately behind the cricoarytenoid joint

31. In the skull


a. The anterior fontanelle usually closes by 2 months
b. The pterion overlies the middle meningeal artery
c. The round foramen transmits the mandibular branch of the fifth cranial nerve
d. The cribriform plate is part of the sphenoid bone
e. All of the above are correct

32. The orbit contains all of the following EXCEPT:


a. Branches of the facial nerve
b. The optic nerve
c. The third cranial nerve
d. A subarachnoid space
e. The inferior rectus muscle

33. Which is true of the trachea?


a. Begins at the level of C7
b. Isthmus of the thyroid lies anterior to the 2nd, 3rd and 4th rings
c. Has 15-20 complete cartilaginous rings
d. Receives its blood supply from the inferior thyroid artery alone
e. Pulmonary artery bifurcates anterior to its lower end

34. Which does not travel through the jugular foramen?


a. Hypoglossal nerve
b. Accessory nerve
c. Inferior petrosal sinus
d. Glossopharyngeal nerve
e. Vagus nerve
35. Regarding veins in the skull
a. Do not follow arteries
b. Lie subdurally
c. Great cerebral vein drains into cavernous sinus
d. ?
e. ?

36. The submandibular ganglion receives fibres from


a. Superior salivatory nucleus
b. ?
c. ?
d. ?
e. ?

37. Which muscle controls vocal cord abduction in the larynx


a. Aryepiglottic
b. Posterior cricoarytenoid
c. Transverse arytenoids
d. Lateral cricoarytenoid
e. Cricothyroid

38. Lumbar vertebrae are distinguishable from thoracic because:


a. They have transverse foramina
b. The bodies are concave from above down
c. Their bodies are kidney shaped and flatter posteriorly
d. They have costal facets
e. Their spinous processes project inferiorly with the tip lying at the body two vertebrae inferiorly

39. Contents of the digastric triangle include all of the following EXCEPT:
a. Facial artery
b. Submandibular lymph nodes
c. Hypoglossal nerve
d. Glossopharyngeal nerve
e. Nerve to mylohyoid

40. The internal carotid artery


a. Is medial to the external carotid artery at its origin
b. Gives rise to the superior thyroid artery
c. Lies outside the carotid sheath
d. Passes through the carotid canal in the base of the skull
e. Lies in the anterior part of the cavernous sinus

41. The C7 cervical vertebra is atypical in that


a. It has bifid spinous process
b. The foramen in the transverse process does not transmit the vertebral artery
c. The anterior tubercle is large
d. It has kidney shaped facets
e. The posterior tubercle gives origin to scalenus anterior
42. Regarding the mandible:
a. The coronoid process is the attachment of temporalis and is posterior to the head of the mandible
b. It is a U-shaped bone without a symphysis
c. The facial artery can be palpated crossing the lower border just posterior to masseter
d. It has a mandibular foramen on its lateral surface
e. Buccinator is attached to the external oblique line

43. The thyroid gland


a. Is penetrated by the recurrent laryngeal nerve
b. Is supplied by the middle thyroid artery
c. Has its isthmus adherent to the 3rd, 4th and 5th tracheal rings
d. Originates from the caudal end of the thyroglossal duct
e. Is contained within the prevertebral fascia

44. Which of the following combinations is correct regarding the paranasal sinuses and where they drain to?
a. Maxillary sinus; middle meatus
b. Anterior ethmoidal air cells; inferior meatus
c. Posterior ethmoidal air cells; oral cavity
d. Sphenoid sinus; frontonasal recess
e. Frontal sinus; lacrimal duct

45. The inferior oblique


a. Arises from the maxilla on the floor of the orbit, near the anterior margin
b. Is attached to the posterosuperior medial quadrant of the sclera
c. Is supplied by the abducent nerve (CN VI)
d. Turns the eye upwards and in
e. Is supplied by the posterior ciliary artery

46. The most important mechanism for airway protection is


a. Depression of larynx
b. Adduction of vestibular folds
c. Elevation of larynx
d. Movement of epiglottis
e. Abduction of vocal cords

47. The recurrent laryngeal nerve


a. Lies in front of the pretracheal fascia
b. Approaches the thyroid gland from above
c. Runs in the groove between the trachea and oesophagus
d. Passes behind the cricothyroid joint
e. Contains only sensory fibres

48. Larynx
a. Continues with the trachea at C6
b. Its major role is for phonation
c. Lies behind the thyroid gland
d. All the muscles are supplied by the receurrent laryngeal nerve
e. Blood supply is from the inferior thyroid artery
49. Which muscle abducts the vocal cords?
a. Transverse arytenoids
b. Cricothyroid
c. Lateral cricoarytenoid
d. Posterior cricoarytenoid
e. Thyoarytenoid

50. The cricoid cartilage


a. Articulates with the thyroid cartilage via fibrocartilage joints
b. Is an incomplete cartilaginous ring
c. Projects anteriorly as a quadrangular flat part
d. Provides attachment for anterior cricoarytenoid muscle
e. Articulates superiorly with the inferior horn of the thyroid cartilage

51. The carotid triangle contains


a. Subclavia artery
b. Omohyoid muscle
c. Occipital artery
d. Internal laryngeal nerve
e. Anterior jugular vein

52. The cervical sympathetic trunk


a. Descends from the upper posterior triangle to the first rib
b. Runs lateral to the vertebral artery
c. Lies behind the carotid sheath
d. Lies behind the prevertebral fascia
e. Ends at the inferior cervical ganglion

53. The carotid sheath


a. Extends from the base of the skull to the bifurcation of common carotid
b. Contains the stylohyoid ligament
c. Contains only three cranial nerves
d. Is attached to the aorta
e. Contains the sympathetic trunk

54. Regarding the vertebrae


a. Spinal nerves emerge through foramina between the vertebral laminae
b. The anterior longitudinal ligament extends from the anterior tubercle of the atlas to the upper part of the
lumbar spine
c. Articular processes are joined to adjacent vertebrae by synovial joints
d. The ligamentum flavum joins borders of adjacent spinous processes
e. A typical thoracic vertebra has foramina in the transverse processes

55. When performing a lumbar puncture the spinal needle should not pass through the
a. Ligamentum flavum
b. Posterior longitudinal ligament
c. Supraspinous ligament
d. Inerspinous ligament
e. Skin
56. All the following are branches of the external carotid artery EXCEPT:
a. Lingual artery
b. Facial artery
c. Ascending pharyngeal artery
d. Hypoglossal artery
e. Superior thyroid artery

57. The alar ligaments connect the


a. Bodies of the axis to foramen magnum
b. Dens to foramen magnum
c. Adjacent vertebral bodies posteriorly
d. Tips of adjacent spinous processes
e. Adjacent laminae

58. All the following are boundaries of the named triangle except:
a. Mandible and submental triangle
b. Mandible and anterior triangle
c. Mandible and digastric triangle
d. Sternocleidomastoid and carotid triangle
e. Sternocleidomastoid and anterior triangle

59. All the following are contents of the posterior triangle EXCEPT:
a. Accessory nerve
b. Cervical plexus
c. Inferior belly of omohyoid
d. Transverse cervical vessels
e. Occipital lymph nodes

60. Which of the following enters into the inferior meatus of the nose?
a. Frontal sinus
b. Ethmoidal sinus
c. Maxillary sinus
d. Nasolacrimal duct
e. Auditory tube

61. A fracture through the roof of the maxillary sinus might result in sensory loss to the
a. Tympanicmembrane
b. Lacrimal gland
c. Upper molar teeth
d. Upper incisors and canine teeth
e. Skin overlying the zygomatic bone

62. All the following structures pass through the jugular foramen EXCEPT:
a. Jugular vein
b. Glossopharyngeal nerve
c. Hypoglossal nerve
d. Accessory nerve
e. Vagus nerve
63. Which is true of swallowing?
a. It is entirely voluntary
b. The oropharyngeal portion is voluntary
c. Peristalsis speeds as the bolus descends
d. The voluntary stage commences as food enters the oesophagus
e. It is initially voluntary then involuntary

64. Which muscle controls vocal cord abduction?


a. Aryepiglottic
b. Transverse arytenoids
c. Lateral cricoarytenoid
d. Posterior cricoarytenoid
e. Cricothyroid

65. What exits the stylomastoid foramen?


a. Middle meningeal artery
b. Accessory nerve
c. Facial nerve
d. Artery to stapedius
e. Hypoglossal nerve

66. Which vessel supplies a branch which passes through the foramen spinosum?
a. ?
b. ?
c. maxillary artery
d. ?
e. ?

67. submandibular ganglion


a. ?
b. ?
c. ?
d. ?
e. ?
1. c? 35. ?
2. a 36. ?
3. a 37. b
4. b 38. ?
5. b 39. ?
6. d 40. ?
7. d 41. ?
8. d 42. ?
9. d 43. ?
10. b 44. a
11. d 45. a
12. d 46. ?
13. d 47. d and ?c
14. c 48. a
15. b 49. d
16. a 50. e
17. ? 51. d
18. d 52. c
19. e 53. d
20. c 54. c
21. a 55. b
22. e 56. d
23. d 57. b
24. c 58. a
25. b 59. e
26. e 60. d
27. c 61. d
28. c 62. c
29. b 63. e
30. d 64. d
31. ? 65. c
32. a 66. c
33. ? 67. ?
34. ?
Thorax MCQs
1. Regarding the anterior body wall
a. The umbilicus receives cutaneous innervation from T8
b. The neurovascular bundle lies between the external and the internal intercostal muscles
c. The nipple receives cutaneous innervation from T6
d. The intercostal nerve lies inferior to the intercostal artery
e. The suprapubic skin is innervated by T10

2. The oesophageal opening in the diaphragm transmits all except:


a. Vagal nerve trunk
b. Oesophageal branches of gastric artery
c. Lymphatics
d. Right phrenic nerve
e. Veins – oesophageal branches of gastric veins

3. The vena caval opening foramen in the diaphragm lies at the level of
a. T12
b. T8
c. T10
d. L1
e. C7

4. Regarding the descending part of the thoracic aorta


a. It is a component of the middle mediastinum
b. It begins at the level of T3 vertebra
c. It passes through the diaphragm behind the lateral arcuate ligament
d. It begins at the beginning of the arch of the aorta
e. It passes to the abdomen at the level of T12

5. Regarding surface markings of the lungs the following is true


a. Apex of lungs rises 5cm above the lateral third of clavicle
b. Oblique fissure follows approximately the axis of 6th rib
c. The two pleura diverge away at 6th costal cartilage level behind sternum
d. Transverse fissure of right lung is at 6th costal cartilage level
e. Oblique fissure following medial border of scapula on abducted arm

6. Which heart valve has two cusps?


a. Aortic
b. Mitral
c. Pulmonary
d. Pulmonary and aortic
e. Tricuspid

7. In the lung
a. The horizontal fissue is always present in the right side
b. The fissures create a roughened surface to promote easier expansion
c. The obliquity of the fissure ensures better expansion of the apex of the lung
d. The lingual is a separate lobe of the left side
e. Only 2% of lungs have incomplete oblique fissures
8. The right phrenic nerve
a. Passes down through the mediastinum posterior to the lung root
b. Is the sole motor supply to the right dome of diaphragm and crus
c. Gives off the right recurrent laryngeal nerve in the neck
d. Contains 50% motor and 50% sensory fibres
e. Divides into two main branches on the under surface of diaphragm

9. Within the thoracic inlet


a. The oesophagus lies against the body of C5
b. The arch of aorta passes from right to left
c. On the right side, the trachea is separated from the vagus nerve and apex of the lung
d. The veins entering the superior mediastinum lie behind the arteries
e. The trachea touches the jugular notch of the manubrium

10. Left dominance means


a. Left side of the heart is more important
b. Posterior interventricular branch is given off from right coronary artery
c. Posterior interventricular branch is given off bya a large anterior interventricular artery traveling off left
coronary artery
d. It is more common than right dominance
e. It is given off directly from left coronary artery

11. In the chest wall


a. The intercostal artery is more superficial than the vein
b. The intercostal artery lies between the intercostal nerve and vein
c. The transverses muscle lies between the external and internal intercostals
d. The neurovascular bundle lies between the external and internal intercostals
e. All of the above

12. The oesophageal opening in the diaphragm is opposite


a. T6
b. T8
c. T10
d. T11
e. T12

13. The most superficial structure in the thoracic inlet is


a. Vagus nerve
b. Right subclavian artery
c. Left subclavian artery
d. Thoracic duct
e. Superior vena cava

14. The diaphragm


a. Has the oesophageal opening opposite T8 vertebra
b. Is supplied by the 5th, 6th and 7th cervical nerve roots
c. Has a major role in expiration
d. Has a vena caval foramen opposite T10 vertebra
e. Has an aortic opening opposite T12 vertebra
15. In the thorax
a. The carina lies at the level of the upper border of the T4 vertebra in the cadaver
b. The thoracic duct drains into the superior vena cava
c. C4 and T3 are adjacent dermatomes
d. The trachea lies in contact with the manubrium
e. The apex of the lung is above the thoracic inlet

16. Which of the following is not true of the surface markings of the left pleura?
a. It lies behind the sternoclavicular joint
b. It lies in the midline behind the angle of Louis
c. It lies at the level of the 6th rib in the midclavicular line
d. It crosses the midaxillary line at the level of the 10th rib
e. It crosses the 12th rib at the lateral border of the sacrospinalis muscle

17. In the anatomical position, the heart:


a. Has a right border comprised of right atrium and right ventricle
b. Has an anterior (sternocostal) surface comprised of right atrium, right ventricle and a strip of left ventricle
c. Has a posterior surface comprised of left atrium, 4 pulmonary veins and left ventricle
d. Has an inferior (diaphragmatic) surface comprised of left atrium, inferior vena cava and right ventricle
e. All of the above are true

18. With respect to the contents of the posterior mediastinum, all are true except:
a. The oesophagus extends from the level of cricoid cartilage to traverse the diaphragm at T10
b. The descending thoracic aorta gives off the posterior intercostals arteries
c. It contains the perihilar lymph nodes
d. The oesophagus is 25cm in length
e. The descending aorta commences at the lower level of T4 vertebra

19. Which is true of the sternum?


a. Jugular notch lies at the level of T4
b. 2nd costal cartilage articulates separately with the manubrium and the body of the sternum
c. sternohyoid attaches to the manubrium, below the 1st costal cartilage
d. interclavicular ligament makes no attachment to the sternum
e. posterior surface of the manubrium is completely covered with pleura

20. Which is not a true muscle attachment to the ribs?


a. Pectoralis mnior – anterior surface of ribs 3-5
b. Serratus posterior superior – lateral to the angle of ribs 2-5
c. Internal oblique – inner surface of last 6 costal cartilages
d. Levator costae – lateral to tubercle, on upper border
e. Rectus abdominus – anterior surface of 5th-7th cartilages

21. Which is not a feature of a typical rib?


a. Medial facet of the tubercle faces backwards
b. Angle is the most posterior point
c. Necks are all of equal length
d. There are 3 costotransverse ligaments
e. Intraarticular ligament attaches from horizontal ridge on the head to the intervertebral disc
22. Which is true of the first rib?
a. Scalenus medius attaches to the scalene tubercle
b. Subclavian vein lies in the subclavian groove
c. Supreme intercostals vein lies medial to the superior intercostals artery
d. Scalenus posterior attaches lateral to the tubercle
e. Head articulates with vertebrae C7 and T1

23. Which is not true of the oesophagus?


a. There is usually a constriction at 27cm from the lips, where the left main bronchus crosses
b. Crosses in front of the descending aorta
c. Upper part drains into the azygos vein
d. Begins at the level of C6 vertebra
e. Receives nerve supply from the recurrent laryngeal nerve

24. Phrenic nerve supplies the sensation to all but


a. Diaphragm
b. Mediastinal pleura
c. Peritoneum
d. Left ventricle
e. Pericardium

25. Which is true of the vagus nerves?


a. Left vagus is held away from the trachea by branches of the aortic arch
b. Run in front of the lung roots
c. Vagal trunks receive fibres from the ipsilateral nerve only
d. Left vagus crosses the aortic arch superficial to the left superior intercostal vein
e. Right vagus runs superficial to the azygos vein

26. Which is true of the thoracic sympathetic trunk


a. Passes into the abdomen behind lateral arcuate ligament
b. Greater splanchnic nerve comes from 3rd to 7th cervical ganglia
c. 1st thoracic ganglion often fuses with the inferior cervical ganglion
d. crosses 1st rib lateral to the superior intercostals artery
e. gives fibres to the oesophageal plexus

27. Pleural reflection lies at which rib level in the midaxillary line?
a. 6th
b. 8th
c. 9th
d. 10th
e. 12th

28. What travels through the diaphragm with the oesophagus?


a. ?
b. ?
c. ?
d. ?
e. ?
29. What lies posterior to the right root of lung
a. Aorta
b. Right phrenic nerve
c. Right vagus nerve
d. ?
e. ?

30. Regarding the right coronary artery


a. Course through the left auricle and infundibulum
b. Supplies 60% of AV nodes
c. Usually has a posterior interventricular branch
d. Supplies 30% of SA nodes
e. ?

31. The thoracic duct


a. Commences level with the body of T10
b. Enters the point of confluence of the left internal jugular and axillary vein
c. Receives the left jugular and subclavian lymph trunks
d. Receives lymph from the right thoracic wall
e. Passes in front of the oesophagus

32. The phrenic nerve


a. Attempts to reach the midline at all levels
b. Is solely motor
c. Lies in front of the lung root
d. Passes through the diaphragm at T12
e. Splits into two main branches on the undersurface of the diaphragm

33. In the chest wall


a. The neurovascular bundle lies between the external and internal intercostals
b. The transverses muscle lies between the internal and external intercostals
c. The intercostal artery lies netween the nerve and vein
d. The intercostal artery is more superficial than the vein
e. All of the above

34. The oesophageal opening in the diaphragm is at


a. T6
b. T8
c. T10
d. T12
e. L1

35. The trachea


a. Drains to axillary lymph nodes
b. Is supplied by glossopharyngeal nerve
c. Is marked at its lower end by the sternal angle
d. Enters the thoracic inlet slightly to the left
e. Commences below the cricoid at the level of C5
36. The most superficial structure in the thoracic inlet is the
a. Vagus nerve
b. Superior vena cava
c. Right subclavian artery
d. Left subclavian artery
e. Thoracic duct

37. The diaphragm


a. Has the oesophageal opening opposite the T8 vertebrae
b. Is supplied by C4, 5, 6
c. Has a major role in expiration
d. Has a vena caval opening at T10
e. Has an aortic opening opposite T12

38. Which passes through the diaphragm with the oesophagus?


a. Azygos vein
b. Right vagus
c. Sympathetic trunks
d. Thoracic duct
e. Phrenic nerves

39. With regard to the coronary arteries


a. Right arises from the posterior coronary sinus
b. Left supplies the conducting system in most patients
c. Right supplies the posterior descending branch in most patients
d. There are no arteriolar anastomoses between left and right
e. ?

40. Regarding bronchopulmonary segments, which is FALSE?


a. There are approximately 10 segments in each lung
b. The lingual is divided into upper and lower segments
c. ?
d. ?
e. ?

41. Which muscle is NOT used in forced expiration?


a. Transverses abdominis
b. Rectus abdominis
c. Diaphragm
d. External oblique
e. Internal oblique

42. Which vessel passes directly behind the right hilum?


a. Right phrenic nerve
b. Right vagus nerve
c. Azygos vein
d. Internal mammary artery
e. Hemi-azygos vein
43. In the superior mediastinum
a. The apex of the left lung abuts the trachea
b. The left vagus is in contact with the trachea
c. The right phrenic descends in contact with SVC
d. The azygos vein hooks under the right main bronchus
e. SVC runs posterior to the right main bronchus

44. Regarding the diaphragm


a. Its fibres arise in continuity with those of the internal oblique muscle
b. It has a central tendon which is fused inseparably to the visceral pericardium
c. Its right crus is fixed to the upper two lumbar vertebrae
d. 95% of its muscle fibres are of the slow twitch fatigue resistant variety
e. its proprioceptive fibres come from the lower intercostal nerves

45. The diaphragm


a. Has an aortic opening which transmits the right vagus nerve
b. Has an oesophageal opening at the level of T8
c. Is pierced by the left phrenic nerve at the left dome
d. Is supplied in its central part mainly by the pericardiophrenic and musculophrenic arteries
e. Has a left dome which lies higher than the right dome

46. The major arterial supply to the interventricular septum originates from the
a. Circumflex artery
b. Marginal artery
c. Posterior descending
d. Anterior descending
e. Conus artery

47. The vagus nerve


a. Arises in a series of rootlets from the pons
b. Lies outside the carotid sheath in the neck
c. Supplies muscles of the larynx via the recurrent laryngeal nerve
d. Passes in front of the root of the lung
e. Has a superior and inferior ganglion within the jugular fossa

48. Regarding the surface markings of the lung and pleura


a. The border of the lung lies two ribs below the pleural reflection
b. The hilum of the lungs lie at the level of T10 verterbra
c. The oblique fissure follows the line of T10 vertebra
d. The oblique fissure follows the line of the 5th rib
e. The horizontal fissure meets the oblique fissure in the left midaxillary line
f. The lower border of the lung lies at the level of the sixth rib in the midaxillary line
1. d 25. a
2. d 26. e
3. b 27. d
4. e 28. ?
5. e 29. c
6. b 30. c
7. c 31. c
8. b 32. c
9. e 33. c
10. c 34. c
11. b 35. c
12. c 36. b
13. e 37. e
14. e 38. b
15. d 39. c
16. c 40. b
17. b 41. c
18. c 42. c
19. b 43. c
20. ? 44. b
21. c 45. c
22. ? 46. c
23. c 47. c
24. d 48. c
Thorax

Section 1

1) Thoracic skeleton:
a) the function of the ribs is primarily to protect the thoracic contents
b) each rib articulates with its own thoracic vertebra and the one above
c) the tubercle of a typical rib has two facets, the lateral facet being non-articular
d) the 2nd to 7th sternocostal joints are synovial type, each with a single cavity
e) the body of the sternum usually fuses with the manubrium with advancing age

2) Diaphragm:
a) median arcuate ligament is at L1
b) vena caval opening transmits IVC and left phrenic nerve
c) oesophageal opening is at T8
d) expiration depends on active contraction of the diaphragm
e) the motor supply to the diaphragm is solely from the phrenic nerves

3) With respect to the thoracic wall, which is TRUE?


a) intercostal and lumbar arteries pass forward in the neurovascular plane between internal and external
oblique
b) lymphatic drainage above the umbilicus drains posteriorly to the scapular (post) group of axillary nodes
c) division of a single intercostal nerve causes anaesthesia in its supply area
d) the thoracoepigastric vein unites the internal thoracic vein and the superficial epigastric vein –
connecting IVC and SUC
e) venous return follows intercostal and lumbar arteries only

4) The oesophagus passes through the diaphragm at the level of T10 vertebra. It is accompanied by:
a) right phrenic nerve
b) left phrenic nerve
c) oesophageal branch of the right gastric artery
d) vagal trunks
e) hemiazygous vein

5) The aorta passes through the diaphragm at the level of T12. It is accompanied by:
a) azygous vein
b) thoracic duct
c) hemiazygous vein
d) a and b correct
e) a, b and c correct

6) The IVC passes through the diaphragm at the level of T8, which is TRUE?
a) this occurs to the left of the midline behind the 7th costal cartilage
b) the left phrenic nerve accompanies it
c) this occurs behind the 8th right costal cartilage
d) the right phrenic nerve accompanies it
e) it passes between the muscular levels of the diaphragm
7) Accessory muscles of inspiration include all EXCEPT:
a) scalene muscles
b) latissimus dorsi
c) sternocleidomastoid
d) quadratus lumborum
e) erector spinae

8) With respect to the superior mediastinum, which is FALSE?


a) the trachea is separated from the apex of the left lung by the left common carotid and left subclavian
b) the SUC and brachiocephalic veins lie anterior to the brachiocephalic trunk
c) the vagus nerve (right) lies medial to the right common carotid artery
d) the trachea bifurcates at the lower limit of the superior mediastinum
e) the thymus lies behind the manubrium

9) With respect to the mediastinum:


a) the vagus nerves pass in front of the lung roots
b) the phrenic nerves pass behind the lung roots
c) the vagus nerves pass behind the lung roots
d) the left phrenic passes anterior to the left bronchus and exits the diaphragm through the IVC opening
e) the right recurrent laryngeal nerve hooks around the ligamentum arteriosum

10) With respect to the cardiac plexuses:


a) the superficial plexus lies to the right of the ligamentum arteriosum, in front of the tracheal bifurcation,
behind the aortic arch
b) the deep plexus is smaller and lies in front of the ligamentum arteriosum
c) the plexuses consist only of sympathetic and parasympathetic fibres
d) pain fibres run with sympathetic nerves → sympathetic ganglia (3 cervical and upper 4-5 thoracic
ganglia of both sides)
e) sympathetic fibres accelerate the heart and constrict the coronary arteries

11) With respect to the heart:


a) the inferior (diaphragmatic) surface is made up of one third right ventricle and two thirds left ventricle,
separated by the posterior interventricular branch of the left coronary artery
b) the right border of the heart extends from the lower border of the right 3rd costal cartilage to the lower
border of the right 6th costal cartilage
c) the posterior surface (base) consists almost entirely of the left atrium receiving the three pulmonary
veins
d) the left border consists of the left ventricle only
e) the right border consists mostly of the right atrium

12) All but which of the following are tributaries of the coronary sinus of the heart?
a) the anterior cardiac vein
b) the great cardiac vein
c) the middle cardiac vein
d) the oblique vein (of the LA)
e) the posterior vein of the LV
13) The posterior mediastinum contains all but which of the following?
a) thoracic aorta
b) oesophagus
c) accessory hemiazygous vein
d) the azygous vein
e) the sympathetic trunks

14) With respect to the root of the lung:


a) the left pulmonary artery is longer than the right
b) the bronchial branch to the upper lobe is separate on the left
c) the pulmonary veins lie anterior and inferior to bronchus
d) the pulmonary ligament connects the right and left lungs directly
e) the pulmonary trunk divides in front of the right main bronchus

15) The deep cardiac plexus:


a) is functionally separate from the superficial cardiac plexus
b) lies to the right of ligamentum arteriosum
c) receives predominantly right phrenic input
d) is posterior to the bifurcation of the trachea
e) is smaller than the superficial cardiac plexus

16) The abdominal inferior vena cava:


a) is shorter than the abdominal aorta
b) enters the thorax through muscular diaphragm at T8
c) creates a groove over the quadrate lobe of liver
d) crosses the right renal and suprarenal arteries
e) commences in front of the right common iliac artery

17) The testicular veins:


a) have valves at their terminations
b) is formed by two venae comitantes in the pelvis
c) enter the inferior vena cava
d) receive the suprarenal veins as tributaries
e) none of the above

18) Regarding the ribs:


a) the 1st costal cartilage articulates with the manubrium by a synovial joint
b) the radiate ligament has two bands, upper and lower
c) the typical ribs are 3rd to 10th
d) the groove for the subclavian artery is anterior to the scalene tubercle on the 1st rib
e) the angle of the 2nd rib is the most posterior part of its curvature

19) Regarding attachments to the thoracic cage:


a) pectoralis major has slips of origin from the upper 8 costal cartilages
b) the first digitation of serratus anterior attaches to the 1st and 2nd rib
c) rectus abdominus is attached to the anterior surfaces of the 7th to 10th costal cartilages
d) iliocostalis and longissimus, parts of erector spinae, are attached between the heads and tubercles of
each rib
e) serratus anterior is attached to the lower 8 ribs
20) In the superior mediastinum:
a) the azygous vein arches under the right main bronchus
b) the right brachiocephalic vein receives the thoracic duct
c) the aortic arch is crossed on the left side by the phrenic and vagus nerves
d) the superficial cardiac plexus contains right and left vagal and sympathetic fibres
e) the superior vena cava receives the azygous vein at the lower border of the right 1st costal cartilage

21) Regarding the pericardium:


a) the superior vena cava does not fuse with the fibrous pericardium
b) the transverse sinus separates the four pulmonary veins
c) the parietal layer of the serous pericardium has no nerve supply
d) the strong sternopericardial ligaments connect fibrous pericardium to upper/lower ends of sternum
e) the oblique sinus permits pulsation of the left atrium

22) Regarding the gastrointestinal tract:


a) the oesophagus enters the abdomen at T8 level
b) the right gastric artery is a branch of the splenic artery
c) the hepatopancreatic ampilla opens into the horizontal part of the duodenum
d) the taeniae coli converge at the ileocaecal valve
e) McBurneys point is one third of the way up the oblique line that joins the right anterior superior iliac
spine to the umbilicus

23) The pelvic splanchnic nerves are:


a) derived from S1, 2, 3, 4
b) motor to the mm of bladder neck and anal sphincter
c) motor to all the gut
d) secretomotor to the gut from splenic flexure dome
e) sympathetic nerves

24) The anterior third of the serotom is supplied by:


a) ilioinguinal nerve
b) sciatic nerve branches
c) peroneal branches of the posterior femoral cutaneous nerve
d) a branch of the pudendal nerve
e) none of the above

25) The ureters:


a) are 25cm long
b) are crossed anteriorly by gonadal vessels
c) leave the psoas muscle at the bifurcation of the common iliac artery
d) are retroperitoneal
e) all of the above

26) Regarding intercostal blood vessels:


a) in each space there are single anterior and posterior intercostal veins
b) right sided superior intercostal vv drain into the brachiocephalic vein
c) the second intercostal space does not contain a posterior intercostal artery
d) all intercostal vv are branches of the descending thoracic aorta
e) all this is clinically relevant
27) Regarding blood supply to the heart:
a) the SA nodal artery is more commonly a branch of the left coronary artery
b) 40% of hearts show “left dominance”
c) the marginal and anterior interventricular arteries are the main branches of the left coronary artery
d) the right coronary artery arises from the posterior aortic sinus
e) the circumflex artery travels in the atrioventricular groove

28) With respect to the bronchi:


a) the carina lies to the left of the midline
b) the left apicoposterior bronchus of the upper lobe rises highest from the posterior surface of the lung
c) each lung has eight segmental bronchi
d) the left main bronchus is shorter than the right
e) blood supply is via the pulmonary arteries

29) The thoracic duct:


a) commences at L1
b) passes through the oesophageal opening of the diaphragm (T10)
c) enters the right side of the superior mediastinum
d) does not drain the right arm
e) terminates in the inferior vena cava

30) The oesophageal opening in the diaphragm transmits:


a) azygous vein
b) vagus nerve
c) right phrenic nerve
d) sympathetic trunk
e) thoracic duct

31) Regarding the intercostal space:


a) the neurovascular space lies deep to the transversus group
b) the collateral nerves lie just above the ribs
c) the first intercostal nerve does not supply muscle
d) the lower third intercostal nerves supply the abdominal wall
e) all intercostal arteries are branches of the descending thoracic aorta

32) The azygous vein:


a) has an avascular fibrous cord in the abdomen
b) begins as the union of ascending lumbar vein with the subcostal vein on the left side
c) arches over the right pulmonary artery
d) receives veins from the upper third of the oesophagus
e) usually enters the brachiocephalic vein

33) Which doesn’t drain into the cardiac sinus?


a) great cardiac vein
b) anterior cardiac vein
c) small cardiac vein
d) oblique vein of the left atrium
e) posterior vein of the left ventricle
34) The cardiac plexus:
a) has a larger superficial part and a smaller deep part
b) is made up of sympathetic and parasympathetic fibres only
c) receives fibres from the left vagus nerve and left cervical sympathetic ganglion only into the superficial
part
d) the deep part lies to the left of the ligamentum arteriosum
e) has preganglionic sympathetic fibres

35) Regarding the pericardium:


a) the transverse sinus separates the four pulmonary veins
b) the parietal layer of the serous pericardium has no nerve supply
c) the fibrous pericardium is fused with the IVC
d) the fibrous pericardium is supplied by the phrenic nerve
e) strong sternopericardial ligaments connect the fibrous pericardium to the sternum

36) Which muscle is not used in inspiration?


a) erector spinae
b) quadratus lumborum
c) latissimus dorsi
d) transversus thoracis
e) pectoralis major

37) Which is not found in the posterior mediastinum?


a) descending thoracic aorta
b) thoracic duct
c) phrenic nerves
d) azygous vein
e) lymph nodes

38) Regarding the phrenic nerves:


a) pass behind anterior scalene muscle
b) the right nerve pierces the muscular part of the diaphragm
c) they are always in contact with pleura laterally
d) run in mediastinum behind the lung root
e) split into four main branches – anterior, posterior, medial and lateral

39) The vagus nerve:


a) the right vagus nerve is in contact with the trachea
b) passes in front of the lung root
c) the right recurrent laryngeal branch hooks around the right subclavian artery
d) passes through the vena caval forearm
e) the right vagus nerve supplies branches to the superficial cardiac plexus

40) Regarding the heart valves:


a) the aortic valve usually has two semilunar cusps
b) the pulmonary valve is at the level of the 3rd costal cartilage
c) they do not contain elastic fibres
d) the tricuspid valve has anterior, posterior and medial cusps
e) the mitral valve cusps are bigger and thinner than those of the tricuspid valve
Thorax

Section 1 – Answer

1 C
2 E
3 B
4 D
5 D
6 D
7 B
8 C
9 C
10 D
11 B
12 A
13 E
14 C
15 B
16 D
17 A
18 E
19 B
20 C
21 E
22 E
23 D
24 A
25 E
26 C
27 E
28 A
29 D
30 B
31 B
32 A
33 B
34 C
35 D
36 D
37 C
38 C
39 A
40 B
Section 2

1) With regard to intercostal spaces:


a) the neurovascular bundle runs in the plane between external intercostal and internal intercostal
muscles
b) neurovascular structures lie in the order of nerve, artery, vein from above downwards
c) the upper two spaces are supplied by the supreme intercostal artery
d) the collateral branches of the intercostal artery and nerve run along the upper border of the rib that
forms the lower boundary of the space
e) the collateral branch of the intercostal nerve supplies skin over the space

2) Which is NOT USUALLY supplied by the left coronary artery?


a) conus artery
b) circumflex artery
c) anterior interventricular artery
d) anterior fibres of left bundle
e) posterior fibres of left bundle

3) Which is NOT a surface marking of the pleura?


a) right and left pleura meet each other in midline anteriorly at level of the sternal angle
b) both cross the midclavicular line at the 6th rib
c) both cross the midaxillary line at the 10th rib
d) both cross the 12th rib at the lateral border of erector spinae
e) both pass under the 12th costovertebral angle

4) Which of the following bronchi is called the epartenol bronchus?


a) left superior bronchus
b) left inferior bronchus
c) right superior bronchus
d) right middle bronchus
e) right inferior bronchus

5) The thoracic duct:


a) is always related to the right side of the aorta
b) receives no lymph drainage from the neck
c) terminates in the superior vena cava
d) may have two or three branches at its termination
e) is entirely thoracic throughout its course

6) Which is NOT a surface marking of the lungs or fissures?


a) hilum of each lung lies level with 5th, 6th and 7th thoracic vertebrae
b) lower border of the lungs lie two ribs higher than the pleural reflection
c) the line of the 6th rib is the marking for the oblique fissures
d) horizontal fissure runs from the right 4th costal cartilage horizontally to mid-axillary line
e) anteromedial border of the left lung in the 5th intercostal space lies at the apex of the heart

7) Regarding the diaphragm:


a) it is active in both inspiration and expiration
b) the aorta is transmitted through an opening in the left crus
c) the left dome may ascend to the 5th intercostal space
d) the phrenic nerve branches run medially on its thoracic surface
e) it receives its blood supply entirely from lower intercostal and subcostal arteries

8) With respect to the sensory innervation of the visceral pericardium, which of the following nerves
predominantly provides sensory fibres?
a) left vagus
b) left phrenic
c) left 4th intercostal
d) all of the above
e) none of the above

9) The oesophagus is constricted at the following sites:


a) where it is crossed by right main bronchus
b) where it is crossed by the azygous vein
c) where it is crossed by the left subclavian artery
d) where it is crossed by the thoracic duct
e) none of the above

10) The sino-atrial node is situated:


a) on the right of the opening of the inferior vena cava
b) within the interatrial septum
c) at the opening of the coronary sinus
d) just above the crista terminalis
e) around the lower superior vena cava

11) A surface landmark which constitutes a guide to the gastro-oesophageal orifice is the:
a) 7th left costal cartilage
b) left linea semilunaris
c) tip of the 9th left costal cartilage
d) left nipple
e) level of the 11th thoracic vertebra

12) Which does NOT form part of the left border of the cardiovascular silhouette on chest x-ray?
a) the arch of the aorta
b) the pulmonary trunk
c) the left atrium
d) the left auricle
e) the left ventricle

13) During expiration, the right diaphragm rises to:


a) 4th intercostal space
b) 5th intercostal space
c) 6th intercostal space
d) a level slightly lower than the left diaphragm
e) the same height as the central tendon
14) Which of the following is NOT true with respect to the ligamentum ateriosum?
a) it arises from the commencement of the left pulmonary artery
b) it joins the aorta at the level of the commencement of the brachiocephalic artery
c) the superficial part of the cardiac plexus lies anterior to it
d) the left recurrent laryngeal nerve hooks around it
e) the deep cardiac plexus lies to its right

15) Landmarks of the trachea are:


a) thyroid cartilage to sternal notch
b) hyoid bone to sternal angle –
c) cricoid cartilage to sternal angle
d) thyroid cartilage to sternal angle
e) cricoid cartilage to sternal notch

16) The oesophagus:


a) is supported inferiorly by a sling of fibres from the left crus of the diaphragm
b) has its narrowest part at the opening of the diaphragm
c) has a blood supply from inferior thyroid arteries, oesophageal branches of aorta and branches of left
gastric artery
d) has no contact with thoracic vertebrae
e) is crossed on the right by the arch of the aorta and azygous vein

17) Regarding the phrenic nerves, all of the following are true, EXCEPT:
a) each nerve provides motor supply to own half of diaphragm, left phrenic also supply half of right
crus
b) the phrenic nerve is supplied by its own pericardiophrenic artery which accompanies it
c) the right phrenic nerve is in contact with venous structures throughout its course
d) the left phrenic nerve passes to the inferior surface of diaphragm through muscle
e) arising mainly from C4 in the neck, the nerve passes behind the anterior scalene

18) Which of the following do not penetrate the diaphragm?


a) aorta
b) inferior vena cava
c) left phrenic nerve
d) right phrenic nerve
e) oesophagus

19) With regard to the thorax:


a) pus behind the prevertebral fascia can gravitate to the posterior mediastinum
b) mediastinal tumours tend to project more into the left hilum than the right
c) pretracheal fascia blends with the pericardium anteriorly
d) pus from the cervical tracheal region may gravitate to the middle mediastinum
e) the arch of the aorta lies in the middle mediastinum

20) The oesophagus:


a) contains smooth muscle in its upper third
b) lies posterior to the left atrium
c) is partly innervated by the phrenic nerve
d) passes through the central tendon at the level of T10 vertebrae
e) has no connective tissue attaching to the aorta
21) With regard to the thoracic wall:
a) the intercostal vessels and nerves run between the external and internal intercostal muscles
b) all intercostal nerves have anterior and lateral cutaneous branches
c) the internal intercostals assist inspiration
d) both the manubriosternal and xiphisternal joints are synovial with discs
e) the upper ribs have ‘pump-handle’ movement NOT ‘bucket handle’ movement

22) Which of the following statements about the diaphragm is NOT true?
a) the oesophageal opening is at the T10 level
b) the aortic opening may also contain the azygous vein and thoracic duct
c) the right dome is higher than the left
d) the blood supply is from the pericardiophrenic artery
e) the vena caval opening is at T8

23) With regard to the cutaneous innervation of the thorax and abdomen:
a) above the 2nd rib, the skin is supplied by the cervical plexus (C4)
b) loss of a single spinal segment will produce a sensory deficit
c) it is supplied segmentally by the anterior primary rami of T1 to L1
d) T8 supplies skin at the level of the umbilicus
e) the lower eight thoracic nerves pass beyond the costal margin to supply the skin of the abdominal
wall

24) With regard to the diaphragm, which is NOT true?


a) in full expiration, the right dome ascends to the level of the nipple
b) the central tendon lies at the level of the xiphisternal joint
c) the longest fibres arise from the 9th costal cartilage
d) the branches of the phrenic nerves run over the thoracic surface radially
e) it is pierced by inferior vena cava at T8 level and by oesophagus at T10 level

25) The trachea:


a) bifurcates at a variable level according to respiration
b) is supplied by the superior thyroid arteries
c) commences at C5 level
d) is non elastic and is supported by cartilaginous rings
e) is in contact with the recurrent laryngeal nerve on the right

26) Which is NOT located at the level of the lower border of T4 vertebra?
a) the most superior part of the arch of the aorta
b) azygous vein enters the superior vena cava
c) thoracic duct reaches the left side of the oesophagus as it ascends
d) ligamentum arteriosum
e) superficial and deep parts of the cardiac plexus

27) In the anatomical position, the heart:


a) has a right border comprised of right atrium and right ventricle
b) has an anterior (sternocostal) surface comprised of right atrium, right ventricle and a strip of left
ventricle
c) has a posterior surface comprised of left atrium, four pulmonary veins and left ventricle
d) has an inferior (diaphragmatic) surface comprised of left atrium, inferior vena cava and right
ventricle
e) all of the above are true
28) Which is NOT USUALLY supplied by the right coronary artery?
a) sinoatrial nodal artery
b) atrioventricular nodal artery
c) conus artery
d) right bundle of HIS
e) posterior part of the interventricular septum

29) With regard to lymphatic drainage in the thorax, which is NOT true?
a) the anterior intercostal spaces drain into parasternal nodes thence to brachiocephalic veins
b) mid-part of oesophagus drains to the paraaortic nodes beside the descending aorta
c) the lower posterior intercostal groups of nodes drain into cysterna chyli
d) the heart drains into the tracheobronchial nodes thence to mediastinal, lymph trunks
e) the mediastinal lymph trunks lie alongside the trachea

30) With regard to the oesophagus, which is NOT true?


a) the upper part is supplied by the recurrent laryngeal nerve
b) the upper third has skeletal muscle whereas the lower two thirds is smooth muscle
c) the narrowest part is where it passes through the diaphragm
d) oesophageal pain can be referred to the neck, arm and thoracic wall
e) pierces the diaphragm at the level of T10 vertebral body

31) With respect to the blood supply of the hearts, which answer is INCORRECT?
a) the left coronary artery and its branches are the main blood supply to the interventricular septum
b) the coronary sinus receives the great cardiac vein
c) anterior cardiac veins drain directly into the right atrium
d) the sinoatrial nodes is, in a majority of cases, supplied by the left coronary artery
e) the right coronary artery gives off a marginal branch at the inferior border of the heart

32) With regard to the phrenic nerve:


a) its fibres are exclusively motor
b) it is predominantly sensory
c) the right phrenic nerve lies anterior to the right lung root
d) it divides into anterior posterior and medial divisions on the thoracic surface of the diaphragm
e) it divides into anterior posterior and medial divisions on the abdominal surface of the diaphragm

33) Regarding the cardiac veins:


a) the great cardiac vein accompanies the posterior descending interventricular artery
b) the middle cardiac vein ends in the right atrium
c) the anterior cardiac vein ends in the right atrium
d) the small cardiac vein accompanies the circumflex branch of the left coronary artery
e) the oblique veins of the left atrium end in the left atrium

34) With regard to the intercostal neurovascular bundle:


a) it maintains a close association with the superior posterior aspect of its own rib
b) it travels in a neurovascular plane between external and internal muscle layers
c) the artery has a longer course around the body wall than the nerve
d) the nerve is always inferior to the artery
e) the vein may travel below the nerve

35) A needle inserted between the xiphoid process and 7th left intercostal cartilage for the purpose of
pericardiocentesis passes through all the following structures EXCEPT:
a) central tendon of diaphragm
b) serous pericardium
c) rectus sheath
d) fibrous pericardium
e) pleura

36) The parietal pleura in an average sized adult male:


a) projects 3cm above the medial third of the upper surface of the clavicle
b) projects 2cm beyond the thoracic outlet
c) projects 1cm above the inner border of the first rib
d) does not project above the upper surface of the clavicle
e) none of the above

37) Regarding the chest wall:


a) the intercostal artery runs between the external and internal intercostal muscles
b) the muscles of outer thoracic wall layer are serratus posterior superior, serratus posterior inferior
only
c) the 5th posterior intercostal vein, artery and nerve run on the lower border of the 5th rib
d) the order of structures in the intercostal space are artery, vein, nerve
e) the 1st intercostal nerve supplies skin over the anterior chest wall

38) The azygous vein:


a) usually enters the right subclavian vein
b) only drains the middle third of the oesophagus
c) only drains part of the oesophagus and bronchial vein
d) passes forward anteriorly medial to the oesophagus from T3
e) arches over the right bronchus at left of T4 vertebra

39) The trachea:


a) starts at the thyroid cartilage
b) bifurcates into the right and left bronchi behind the manubrium – sternal angle
c) passes through the posterior mediastinum
d) is not supplied by the recurrent laryngeal nerve
e) blood supply is from the superior thyroid artery

40) In the thorax:


a) the inlet is bounded by the scapulae, clavicles and sternum
b) the inferior border of the superior mediastinum is level with T4
c) the right phrenic nerve passes through the oesophageal opening
d) the left phrenic nerve passes through the oesophageal opening
e) the thoracic duct passes through the canal opening

41) The sternoclavicular joint:


a) is a simple synovial joint
b) is more likely to dislocate posteriorly than anteriorly
c) is supplied by the cervical plexus
d) undergoes weak active rotation due to the action of subclavius
e) owes most of its strength to a single band of fibres joining clavicle to sternal notch and manubrium
42) In the thorax:
a) the lungs are supported at the hilum by the pulmonary ligament
b) the right lung horizontal fissure lies at the 4th intercostal space
c) the parietal and visceral pleura have rich sensory innervation
d) the hilum of the lung lies at the level of theT7-8 vertebra
e) the dome of the lung rises above the medial one third of the clavicle

43) In the mediastinum:


a) the pulmonary trunk divides anterior to the left main bronchus
b) the pulmonary trunk divides anterior to the carina
c) the left and right lung inferior lobes each have four segments
d) the upper lobe of the right lung reaches the 5th costochondral junction anteriorly in the rest position
e) the left lung inferior lobe has five segments and the right has four

44) In the coronary circulation:


a) the commonest arterial pattern is that of ‘left dominance’
b) the sinoatrial nodal artery arises from the left coronary artery in almost half the population
c) the anterior cardiac veins drain the left ventricle
d) the coronary sinus drains into the left atrium
e) the right coronary artery arises from the posterior aortic sinus

45) The aortic opening in the diaphragm transmits:


a) oesophageal-gastric lymphatics
b) branches of the left gastric artery
c) the left phrenic nerve
d) posterior vaginal plexus
e) azygous vein

46) The azygous vein:


a) passes through the oesophageal hiatus of the diaphragm
b) crosses over the right bronchus at T6
c) drains into the left brachiocephalic vein
d) drains the lower eight intercostal spaces
e) drains the inferior third of the oesophagus

47) In the deepest intercostal muscle layer:


a) the subcostals line the rib cage at the side
b) fibres of the innermost intercostal group only span one intercostal space
c) fibres of the subcostals group only span one intercostal space
d) transversus thoracis fibres only arise from 2nd to 6th costal cartilages
e) the border of the subcostal muscle group meets the innermost intercostal groups, overlapping
slightly so the intercostal artery can slip between them to join the intercostal nerve
Section 2

Answers
1 D
2 E
3 B
4 C
5 D
6 C
7 C
8 E
9 E
10 D
11 A
12 C
13 A
14 B
15 C
16 C
17 E
18 A
19 C
20 B
21 E
22 D
23 A
24 D
25 A
26 A
27 B
28 D
29 B
30 C
31 D
32 C
33 C
34 D
35 E
36 A
37 C
38 E
39 B
40 B
41 C
42 B
43 A
44 B
45 E
46 D
47 D

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