A. Mid Point of The Inguinal Ligament

yomna92009@yahoo.
com - MRCS Part A - My account
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Question 8 of 461 Question stats Score: 87.5%
1
A 40.9%
A 53 year old man presents with an inguinal hernia. Which of the following surface 2
B 26.7%
landmarks may be used to identify the location of the deep inguinal ring? 3
C 15.1%
D 6.5% 4
A. Mid point of the inguinal ligament E 10.8% 5
B. The mid inguinal point 6
40.9% of users answered this
C. The pubic tubercle question correctly
7
D. The medial edge of external oblique
8
E. 2cm supero medially to the femoral artery
Next question
The surface markings of the deep inguinal ring are a commonly examined topic
and should be memorised. The surface marking is the midpoint of the inguinal
ligament. The mid inguinal point is the surface marking for the femoral artery. The
pubic tubercle marks the site of the superficial inguinal ring.
Inguinal canal
Location
Above the inguinal ligament

The inguinal canal is 4cm long
Boundaries of the inguinal canal
Floor External oblique aponeurosis

Inguinal ligament
Lacunar ligament
Roof Internal oblique

Transversus abdominis
Anterior wall External oblique aponeurosis
Posterior wall Transversalis fascia

Conjoint tendon
Laterally Internal ring

Fibres of internal oblique
Medially External ring

Conjoint tendon
Contents
Males Spermatic cord and ilioinguinal As it passes through the canal the spermatic
nerve cord has 3 coverings:
External spermatic fascia from external

oblique aponeurosis
Cremasteric fascia
Internal spermatic fascia
Females Round ligament of uterus and

ilioinguinal nerve
Related anatomy of the inguinal region

The boundaries of Hesselbachs triangle are commonly tested and illustrated
below:
Image sourced from Wikipedia
The image below demonstrates the close relationship of the vessels to the lower
limb with the inguinal canal. A fact to be borne in mind when repairing hernial
defects in this region.
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yomna92009@yahoo.com - MRCS Part A - My account
1
A 19.4%
A 22 year old falls over and lands on a shard of glass. It penetrates the palmar 2
B 10.1%
aspect of his hand, immediately lateral to the pisiform bone. Which of the following 3
C 49.9%
structures is most likely to be injured?
D 10.2% 4
E 10.4% 5
A. Palmar cutaneous branch of the median nerve
49.9% of users answered this 6
B. Lateral tendons of flexor digitorum superficialis question correctly
7
C. Ulnar artery
8
D. Flexor carpi radialis tendons
9
E. Lateral tendons of flexor digitorum profundus
10
Next question 11
12
The ulnar nerve and artery are at most immediate risk in this injury. This is 13
illustrated in the image below:
14
15
16
17
18
Hand
Anatomy of the hand
Bones 8 Carpal bones

5 Metacarpals
14 phalanges
Intrinsic 7 Interossei - Supplied by ulnar nerve

Muscles
3 palmar-adduct fingers
4 dorsal- abduct fingers
Intrinsic Lumbricals
muscles
Flex MCPJ and extend the IPJ.
Origin deep flexor tendon and insertion dorsal extensor hood
mechanism.
Innervation: 1st and 2nd- median nerve, 3rd and 4th- deep
branch of the ulnar nerve.
Thenar Abductor pollicis brevis

eminence Opponens pollicis
Flexor pollicis brevis
Hypothenar Opponens digiti minimi

eminence Flexor digiti minimi brevis
Abductor digiti minimi
Question 2 of 461 Question stats Score: 100%
1
A 17.9%
A 72 year old man is undergoing an open abdominal aortic aneurysm repair. The 2
B 16%
aneurysm is located in a juxtarenal location and surgical access to the neck of
C 45.1%
aneurysm is difficult. Which of the following structures may be divided to improve
D 11.6%
access?
E 9.4%
A. Cisterna chyli 45.1% of users answered this

question correctly
B. Transverse colon
C. Left renal vein
D. Superior mesenteric artery
E. Coeliac axis
Next question
The left renal vein will be stretched over the neck of the anuerysm in this location
and is not infrequently divided. This adds to the nephrotoxic insult of juxtarenal
aortic surgery as a supra renal clamp is also often applied. Deliberate division of
the Cisterna Chyli will not improve access and will result in a chyle leak. Division
of the transverse colon will not help at all and would result in a high risk of graft
infection. Division of the SMA is pointless for a juxtarenal procedure.
Abdominal aorta
Abdominal aortic topography

Origin T12
Termination L4
Posterior relations L1-L4 Vertebral bodies
Anterior relations Lesser omentum

Liver
Left renal vein
Inferior mesenteric vein
Third part of duodenum
Pancreas
Parietal peritoneum
Peritoneal cavity
Right lateral relations Right crus of the diaphragm

Cisterna chyli
Azygos vein
IVC (becomes posterior distally)
Left lateral relations 4th part of duodenum

Duodenal-jejunal flexure
Left sympathetic trunk
The abdominal aorta

1
A 19.1%
Which of the following structures lies posterior to the femoral nerve in the femoral 2
B 27.7%
triangle? 3
C 20.2%
D 25.5% 4
A. Adductor longus E 7.6% 5
B. Pectineus 6
C. Psoas major question correctly
7
D. Iliacus
8
E. None of the above
9
10
Next question
11
The iliacus lies posterior to the femoral nerve in the femoral triangle. The femoral 12
sheath lies anterior to the iliacus and pectineus muscles. 13
14
Femoral nerve
15
Root values L2, 3, 4 16
17
Innervates Pectineus
Sartorius 18
Quadriceps femoris
19
Vastus lateralis/medialis/intermedius
20
Branches Medial cutaneous nerve of thigh

Saphenous nerve
Intermediate cutaneous nerve of thigh
Path
Penetrates psoas major and exits the pelvis by passing under the inguinal
ligament to enter the femoral triangle, lateral to the femoral artery and vein.

Mnemonic for femoral nerve supply
(don't) M I S V Q Scan for PE

M edial cutaneous nerve of the thigh
I ntermediate cutaneous nerve of the thigh
S aphenous nerve
V astus
Q uadriceps femoris
S artorius
PE ectineus
1
A 14.1%
Your consultant decides to perform an open inguinal hernia repair under local 2
B 58.1%
anaesthesia. Which of the following dermatomal levels will require blockade? 3
C 11.1%
D 10.8% 4
A. T10 E 6% 5
B. T12 6
C. T11 question correctly
7
D. S1
E. S2
Next question
Theme from April 2012 Exam
Dermatomes
The common dermatomal levels and cutaneous nerves responsible for them is
illustrated below.
1
A 8.4%
A 45 year old lady develops severe back pain and on examination is found to 2
B 11.7%
have clinical evidence of an L5/ S1 radiculopathy. Her symptoms deteriorate and 3
C 15.1%
eventually a laminectomy is performed. During the surgical approach the
D 46.3% 4
surgeons encounter a tough ligamentous structure lying anterior to the spinous
E 18.5% 5
processes. This structure is most likely to be the:

question correctly
A. Transverse spinal ligament 7
B. Supraspinal ligament 8
C. Anterior longitudinal ligament 9
D. Ligamentum flavum 10
E. Posterior longitudinal ligament
Next question
The ligamentum lies in this position, as illustrated below:
Vertebral column
There are 7 cervical, 12 thoracic, 5 lumbar, and 5 sacral vertebrae.

The spinal cord segmental levels do not necessarily correspond to the
vertebral segments. For example, while the C1 cord is located at the C1
vertebra, the C8 cord is situated at the C7 vertebra. While the T1 cord is
situated at the T1 vertebra, the T12 cord is situated at the T8 vertebra.
The lumbar cord is situated between T9 and T11 vertebrae. The sacral
cord is situated between the T12 to L2 vertebrae.
Cervical vertebrae
The interface between the first and second vertebra is called the atlanto-axis
junction. The C3 cord contains the phrenic nucleus. The cervical cord innervates
the deltoids (C4), biceps (C4-5), wrist extensors (C6), triceps (C7), wrist extensors
(C8), and hand muscles (C8-T1).
Thoracic vertebrae
The thoracic vertebral segments are defined by those that have a rib. The spinal
roots form the intercostal nerves that run on the bottom side of the ribs and these
nerves control the intercostal muscles and associated dermatomes.
Lumbosacral vertebrae
Form the remainder of the segments below the vertebrae of the thorax. The
lumbosacral spinal cord, however, starts at about T9 and continues only to L2. It
contains most of the segments that innervate the hip and legs, as well as the
buttocks and anal regions.
Cauda Equina
The spinal cord ends at L2 vertebral level. The tip of the spinal cord is called the
conus. Below the conus, there is a spray of spinal roots that is called the cauda
equina. Injuries below L2 represent injuries to spinal roots rather than the spinal
cord proper.
1
A 14.4%
An occlusion of the anterior cerebral artery may compromise the blood supply to 2
B 18.5%
the following structures except: 3
C 13.4%
D 11.1%
A. Medial inferior surface of the frontal lobe E 42.6%
B. Corpus callosum
C. Medial surface of the frontal lobe question correctly
D. Olfactory bulb
E. Brocas area
Next question
Brocas area is usually supplied by branches from the middle cerebral artery.
Circle of Willis
May also be called the circulus arteriosus
Inferior surface of brain

Supplied by the internal carotid arteries and the vertebral arteries
If artery is occluded, collaterals may be able to compensate
Components include:
1. Anterior communicating arteries

2. Anterior cerebral arteries
3. Internal carotid arteries
4. Posterior communicating arteries
5. Posterior cerebral arteries and the termination of the basilar artery
Supply: Corpus striatum, internal capsule, diencephalon, midbrain

Vertebral arteries
Enter the cranial cavity via foramen magnum

Lie in the subarachnoid space
Ascend on anterior surface of medulla oblongata
Unite to form the basilar artery at the base of the pons
Branches:
Posterior spinal artery

Anterior spinal artery
Posterior inferior cerebellar artery
Basilar artery
Branches:
Anterior inferior cerebellar artery

Labyrinthine artery
Pontine arteries
Superior cerebellar artery
Posterior cerebral artery
Internal carotid arteries

Branches:
Posterior communicating artery

Anterior cerebral artery
Middle cerebral artery
Anterior choroid artery
1
A 10.6%
Which of the following structures does not pass through the foramen ovale? B 12.1%
C 41.5%
A. Lesser petrosal nerve D 11.3%
B. Accessory meningeal artery E 24.5%
C. Maxillary nerve 41.5% of users answered this

question correctly
D. Emissary veins
E. Otic ganglion
Next question
Mnemonic: OVALE
O tic ganglion
V3 (Mandibular nerve:3rd branch of trigeminal)
A ccessory meningeal artery
L esser petrosal nerve
E missary veins
Foramina of the base of the skull
Foramen Location Contents
Foramen Sphenoid Otic ganglion

ovale bone V3 (Mandibular nerve:3rd branch of
trigeminal)
Accessory meningeal artery
Lesser petrosal nerve
Emissary veins
Foramen Sphenoid Middle meningeal artery

spinosum bone Meningeal branch of the Mandibular nerve
Foramen Sphenoid Maxillary nerve (V2)

rotundum bone
Foramen Sphenoid Base of the medial pterygoid plate.
lacerum bone Internal carotid artery

Nerve and artery of the pterygoid canal
Jugular Temporal Anterior: inferior petrosal sinus

foramen bone Intermediate: glossopharyngeal, vagus, and accessory nerves.
Posterior: sigmoid sinus (becoming the internal jugular vein) and
some meningeal branches from the occipital and ascending
pharyngeal arteries.
Foramen Occipital Anterior and posterior spinal arteries

magnum bone Vertebral arteries
Medulla oblongata
Stylomastoid Temporal Stylomastoid artery

foramen bone Facial nerve
Superior Sphenoid Oculomotor nerve (III)

orbital bone trochlear nerve (IV)
fissure lacrimal, frontal and nasociliary branches of ophthalmic nerve
(V1)
abducent nerve (VI)
Superior and inferior ophthalmic vein
Base of skull anatomical overview

1
A 9.2%
A 73 year old lady presents with symptoms of faecal incontinence. On 2
B 45.8%
examination she has weak anal sphincter muscles. What are the main nerve root 3
C 15.6%
values of the nerves supplying the external anal sphincter?
D 16.1% 4
E 13.3% 5
A. S5
B. S2,3,4 question correctly
7
C. S2,3
8
D. S4,5
9
E. L5, S1
10
Next question 11
12
Theme from September 2011 Exam 13
14
The external anal sphincter is innervated by the inferior rectal branch of the
pudendal nerve, this has root values of S2, 3 and the perineal branch of S4. 15
16
Anal sphincter
17
Internal anal sphincter composed of smooth muscle continuous with the

circular muscle of the rectum. It surrounds the upper two- thirds of the anal
canal and is supplied by sympathetic nerves.
External anal sphincter is composed of striated muscle which surrounds the
internal sphincter but extends more distally.
The nerve supply of the external anal sphincter is from the inferior rectal
branch of the pudendal nerve (S2 and S3) and the perineal branch of the
S4 nerve roots.
Image showing relationship of internal and external anal sphincters

1
A 10.8%
A 72 year old man has a fall. He is found to have a fractured neck of femur and 2
B 5.5%
goes on to have a left hip hemiarthroplasty. Two months post operatively he is 3
C 27.8%
found to have an odd gait. When standing on his left leg his pelvis dips on the
D 5.1% 4
right side. There is no foot drop. What is the cause?
E 50.7% 5

A. Sciatic nerve damage
question correctly
7
B. L5 radiculopathy
8
C. Inferior gluteal nerve damage
D. Previous poliomyelitis 9
E. Superior gluteal nerve damage 10
11
Next question 12
13
Theme from 2010 Exam
14
This patient has a trendelenburg gait caused by damage to the superior gluteal 15
nerve causing weakness of the abductor muscles. Classically a patient is asked to 16
stand on one leg and the pelvis dips on the opposite side. The absence of a foot
17
drop excludes the possibility of polio or L5 radiculopathy.
18
Gluteal region 19
Gluteal muscles
Gluteus maximus: inserts to gluteal tuberosity of the femur and iliotibial tract
Gluteus medius: attach to lateral greater trochanter
Gluteus minimis: attach to anterior greater trochanter
All extend and abduct the hip
Deep lateral hip rotators
Piriformis
Gemelli
Obturator internus
Quadratus femoris
Nerves
Superior gluteal nerve (L5, S1) Gluteus medius

Gluteus minimis
Tensor fascia lata
Inferior gluteal nerve Gluteus maximus
Damage to the superior gluteal nerve will result in the patient developing a
Trendelenberg gait. Affected patients are unable to abduct the thigh at the hip
joint. During the stance phase, the weakened abductor muscles allow the pelvis to
tilt down on the opposite side. To compensate, the trunk lurches to the weakened
side to attempt to maintain a level pelvis throughout the gait cycle. The pelvis
sags on the opposite side of the lesioned superior gluteal nerve.
1
A 48.1%
At which level is the hilum of the left kidney located? 2
B 24.9%
C 11.8% 3
A. L1 D 6.2% 4
B. L2 E 8.9% 5
C. T12 48.1% of users answered this 6

question correctly
D. T11 7
E. L3 8
9
Next question
10
11
Theme from April 2012 exam
12
Remember L1 ('left one') is the level of the hilum of the left kidney. This is 13
commonly tested in the mrcs exam.
14
15
Renal anatomy
Each kidney is about 11cm long, 5cm wide and 3cm thick. They are located in a
deep gutter alongside the projecting verterbral bodies, on the anterior surface of
psoas major. In most cases the left kidney lies approximately 1.5cm higher than
the right. The upper pole of both kidneys approximates with the 11th rib (beware
pneumothorax during nephrectomy). On the left hand side the hilum is located at
the L1 vertebral level and the right kidney at level L1-2. The lower border of the
kidneys is usually alongside L3.
The table below shows the anatomical relations of the kidneys:
Relations
Relations Right Kidney Left Kidney
Posterior Quadratus lumborum, diaphragm, Quadratus lumborum, diaphragm,

psoas major, transversus abdominis psoas major, transversus abdominis
Anterior Hepatic flexure of colon Stomach, Pancreatic tail
Superior Liver, adrenal gland Spleen, adrenal gland
Fascial covering
Each kidney and suprarenal gland is enclosed within a common and layer of
investing fascia that is derived from the transversalis fascia into anterior and
posterior layers (Gerotas fascia).
Renal structure
Kidneys are surrounded by an outer cortex and an inner medulla which usually
contains between 6 and 10 pyramidal structures. The papilla marks the innermost
apex of these. They terminate at the renal pelvis, into the ureter.
Lying in a hollow within the kidney is the renal sinus. This contains:
1. Branches of the renal artery
2. Tributaries of the renal vein
3. Major and minor calyces's
4. Fat
Structures at the renal hilum

The renal vein lies most anteriorly, then renal artery (it is an end artery) and the
ureter lies most posterior.

1
A 61%
A 24 year old lady is stabbed in the buttock. Following the injury the wound is 2
B 13%
sutured in the emergency department. Eight weeks later she attends the clinic, as 3
C 4.6%
she walks into the clinic room she has a waddling gait and difficulty with thigh
D 15.2% 4
abduction. On examination she has buttock muscle wasting. Which nerve has
E 6.3% 5
been injured?
61% of users answered this 6

question correctly
A. Superior gluteal 7
B. Obturator 8
C. Femoral 9
D. Sciatic 10
E. None of the above 11
12
Next question
13
14
Theme from April 2012 Exam
Damage to the superior gluteal nerve will result in a Trendelenberg gait.
Trendelenberg test
Injury or division of the superior gluteal nerve results in a motor deficit that
consists of weakened abduction of the thigh by gluteus medius, a disabling
gluteus medius limp and a compensatory list of the body weakened gluteal side.
The compensation results in a gravitational shift so that the body is supported on
the unaffected limb.
When a person is asked to stand on one leg the gluteus medius usually contracts
as soon as the contralateral leg leaves the floor, preventing the pelvis from
dipping towards the unsupported side. When a person with paralysis of the
superior gluteal nerve is asked to stand on one leg, the pelvis on the
unsupported side descends, indicating that the gluteus medius on the affected
side is weak or non functional ( a positive Trendelenberg test).
1
A 12.5%
An 18 year old man undergoes a tonsillectomy for attacks of recurrent acute 2
B 55.6%
tonsillitis. Whilst in recovery he develops a post operative haemorrhage. Which of 3
C 13.7%
the following vessels is the most likely culprit?
D 7.3% 4
E 10.9% 5
A. Facial vein
B. External palatine vein question correctly
7
C. External carotid artery
8
D. Internal jugular vein
9
E. None of the above
10
Next question 11
12
The external palatine vein lies immediately lateral to the tonsil and if damaged
may be a cause of reactionary haemorrhage following tonsillectomy.
Tonsil
Anatomy
Each palatine tonsil has two surfaces, a medial surface which projects into
the pharynx and a lateral surface that is embedded in the wall of the
pharynx.
They are usually 25mm tall by 15mm wide, although this varies according to
age and may be almost completely atrophied in the elderly.
Their arterial supply is from the tonsillar artery, a branch of the facial
artery.
Its veins pierce the constrictor muscle to join the external palatine or facial
veins. The external palatine vein is immediately lateral to the tonsil, which
may result in haemorrhage during tonsillectomy.
Lymphatic drainage is the jugulodigastric node and the deep cervical
nodes.
Tonsillitis
Usually bacterial (50%)- group A Streptococcus. Remainder viral.

May be complicated by development of abscess (quinsy). This may distort
the uvula.
- Indications for tonsillectomy include recurrent acute tonsillitis, suspected

malignancy, enlargement causing sleep apnoea.
- Dissection tonsillectomy is the preferred technique with haemorrhage being the
commonest complication. Delayed otaligia may occur owing to irritation of the
glossopharyngeal nerve.
1
A 21%
Where is the 'safe triangle' for chest drain insertion located? 2
B 64%
C 4.4% 3
A. 4th intercostal space, mid axillary line D 5.3% 4
B. 5th intercostal space, mid axillary line E 5.4% 5
C. 4th intercostal space, mid scapular line 64% of users answered this 6
question correctly
D. 5th intercostal space, mid scapular line
E. 4th intercostal space, mid clavicular line
Next question
'Safe Triangle' for chest drain insertion:
5th intercostal space, mid axillary line
Chest drains
There are a number of different indications for chest drain insertion. In general
terms large bore chest drains are preferred for trauma and haemothorax
drainage. Smaller diameter chest drains can be used for pneumothorax or pleural
effusion drainage.
Insertion can be performed either using anatomical guidance or through

ultrasound guidance. In the exam, the anatomical method is usually tested.
It is advised that chest drains are placed in the 'safe triangle'. The triangle is
located in the mid axillary line of the 5th intercostal space. It is bordered by:
Anterior edge latissimus dorsi, the lateral border of pectoralis major, a line
superior to the horizontal level of the nipple, and the apex below the axilla.
Another triangle is situated behind the scapula. It is bounded above by the

trapezius, below by the latissimus dorsi, and laterally by the vertebral border of
the scapula; the floor is partly formed by the rhomboid major. If the scapula is
drawn forward by folding the arms across the chest, and the trunk bent forward,
parts of the sixth and seventh ribs and the interspace between them become
subcutaneous and available for auscultation. The space is therefore known as
the triangle of auscultation.
References
Prof Harold Ellis. The applied anatomy of chest drains insertions. British Journal
of hospital medicine 2007; 68: 44-45
Laws D, Neville E, Duffy J. BTS guidelines for insertion of chest drains.

Thorax,May 2003; 58: ii53-ii59.
1
A 22.4%
At which level does the aorta perforate the diaphragm? 2
B 3.3%
C 14.7% 3
A. T10 D 5.6% 4
B. T9 E 54.1% 5
C. T8 54.1% of users answered this 6

question correctly
D. T11 7
E. T12 8
9
Next question
10
11
Memory aid: 12
T8 (8 letters) = vena cava
13
T10 (10 letters) = oesophagus
T12 (12 letters) = aortic hiatus
Diaphragm apertures
Diaphragm aperture levels
Vena cava T8
Oesophagus T10
Aortic hiatus T12
1
A 17.5%
Which of the following structures suspends the spinal cord in the dural sheath? 2
B 13.9%
C 23.5% 3
A. Filum terminale D 36% 4
B. Conus medullaris E 9.1% 5
C. Ligamentum flavum 36% of users answered this

question correctly
D. Denticulate ligaments
E. Anterior longitudinal ligament
Next question
The spinal cord is approximately 45cm in men and 43cm in women. The
denticulate ligament is a continuation of the pia mater (innermost covering of the
spinal cord) which has intermittent lateral projections attaching the spinal cord to
the dura mater.
Spinal cord
Located in a canal within the vertebral column that affords it structural

support.
Rostrally is continues to the medulla oblongata of the brain and caudally it
tapers at a level corresponding to the L1-2 interspace (in the adult), a
central structure, the filum terminale anchors the cord to the first coccygeal
vertebra.
The spinal cord is characterised by cervico-lumbar enlargements and
these, broadly speaking, are the sites which correspond to the brachial and
lumbar plexuses respectively.
There are some key points to note when considering the surgical anatomy of the
spinal cord:
* During foetal growth the spinal cord becomes shorter than the spinal canal,
hence the adult site of cord termination at the L1-2 level.
* Due to growth of the vertebral column the spine segmental levels may not
always correspond to bony landmarks as they do in the cervical spine.
* The spinal cord is incompletely divided into two symmetrical halves by a dorsal
median sulcus and ventral median fissure. Grey matter surrounds a central
canal that is continuous rostrally with the ventricular system of the CNS.
* The grey matter is sub divided cytoarchitecturally into Rexeds laminae.
* Afferent fibres entering through the dorsal roots usually terminate near their
point of entry but may travel for varying distances in Lissauers tract. In this way
they may establish synaptic connections over several levels
* At the tip of the dorsal horn are afferents associated with nociceptive stimuli.
The ventral horn contains neurones that innervate skeletal muscle.
The key point to remember when revising CNS anatomy is to keep a clinical
perspective in mind. So it is worth classifying the ways in which the spinal cord
may become injured. These include:
Trauma either direct or as a result of disc protrusion

Neoplasia either by direct invasion (rare) or as a result of pathological
vertebral fracture
Inflammatory diseases such as Rheumatoid disease, or OA (formation of
osteophytes compressing nerve roots etc.
Vascular either as a result of stroke (rare in cord) or as complication of
aortic dissection
Infection historically diseases such as TB, epidural abscesses.
The anatomy of the cord will, to an extent dictate the clinical presentation. Some
points/ conditions to remember:
Brown- Sequard syndrome-Hemisection of the cord producing ipsilateral

loss of proprioception and upper motor neurone signs, plus contralateral
loss of pain and temperature sensation. The explanation of this is that the
fibres decussate at different levels.
Lesions below L1 will tend to present with lower motor neurone signs
1
A 45.4%
Following an oesophagogastrectomy the surgeons will anastomose the 2
B 32.6%
oesophageal remnant to the stomach, which of the following is not part of the 3
C 9.2%
layers that comprise the oesophageal wall?
D 7.4% 4
E 5.4%
A. Serosa
B. Adventitia question correctly
C. Muscularis propria
D. Submucosa
E. Mucosa
Next question
The wall lacks a serosa which can make the wall hold sutures less securely.
Oesophagus
25cm long
Starts at C6 vertebra, pierces diaphragm at T10 and ends at T11
Squamous epithelium
Constrictions of the oesophagus

Structure Distance from incisors
Cricoid cartilage 15cm
Arch of the Aorta 22.5cm
Left principal bronchus 27cm
Diaphragmatic hiatus 40cm
Relations
Anteriorly Trachea to T4
Recurrent laryngeal nerve
Left bronchus, Left atrium
Diaphragm
Posteriorly Thoracic duct to left at T5

Hemiazygos to right T8
Descending aorta
First 2 intercostal branches of aorta
Left Thoracic duct

Left subclavian artery
Right Azygos vein
Arterial, venous and lymphatic drainage of the oesophagus

Artery Vein Lymphatics Muscularis externa
Upper Inferior Inferior thyroid Deep Striated muscle

third thyroid cervical
Mid third Aortic Azygos branches Mediastinal Smooth & striated

branches muscle
Lower Left gastric Posterior mediastinal and Gastric Smooth muscle

third coeliac
Nerve supply
Upper half is supplied by recurrent laryngeal nerve
Lower half by oesophageal plexus (vagus)
Histology
Mucosa :Nonkeratinized stratified squamous epithelium

Submucosa: glandular tissue
Muscularis externa (muscularis): composition varies. See table
Adventitia

A. Mid Point of The Inguinal Ligament

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A. Mid Point of The Inguinal Ligament

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yomna92009@yahoo.

com - MRCS Part A - My account

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Question 8 of 461 Question stats Score: 87.5%

Above the inguinal ligament

Boundaries of the inguinal canal

Floor External oblique aponeurosis

Roof Internal oblique

Anterior wall External oblique aponeurosis

Posterior wall Transversalis fascia

Laterally Internal ring

Medially External ring

External spermatic fascia from external

Females Round ligament of uterus and

Related anatomy of the inguinal region

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Question 18 of 461 Question stats Score: 66.7%

Anatomy of the hand

Bones 8 Carpal bones

Intrinsic 7 Interossei - Supplied by ulnar nerve

Thenar Abductor pollicis brevis

Hypothenar Opponens digiti minimi

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Question 2 of 461 Question stats Score: 100%

A. Cisterna chyli 45.1% of users answered this

Abdominal aortic topography

Posterior relations L1-L4 Vertebral bodies

Anterior relations Lesser omentum

Right lateral relations Right crus of the diaphragm

Left lateral relations 4th part of duodenum

The abdominal aorta

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Question 20 of 461 Question stats Score: 70%

Root values L2, 3, 4 16

Branches Medial cutaneous nerve of thigh

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Mnemonic for femoral nerve supply

(don't) M I S V Q Scan for PE

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Question 7 of 461 Question stats Score: 85.7%

Theme from April 2012 Exam

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Question 10 of 461 Question stats Score: 80%

46.3% of users answered this 6

C. Anterior longitudinal ligament 9

E. Posterior longitudinal ligament

The ligamentum lies in this position, as illustrated below:

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There are 7 cervical, 12 thoracic, 5 lumbar, and 5 sacral vertebrae.

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