Chapter 2a – Anatomy Questions




Abstract




Anatomy Questions





Chapter 2a Anatomy Questions




Question 1




Veins in the neck are often used for intravascular access. The anatomical landmarks are important in identifying the vessel in scenarios without ultrasound guidance. Which of the following statements are true?




  1. a. The internal jugular vein begins at the jugular foramen and is accompanied by the glossopharyngeal, vagus and accessory nerves as they exit the skull



  2. b. The internal jugular vein terminates at the subclavian vein



  3. c. The carotid sheath contains the internal jugular vein, the vagus nerve and the common carotid artery



  4. d. The anterior triangle of the neck is formed by the sternocleidomastoid, the mandible and the mid-line of the neck



  5. e. The superior thyroid vein is one of the tributaries of the internal jugular vein and must be divided first during a thyroidectomy in order to stop bleeding



Question 2




With regards to the large veins of the neck, which of the following are true?




  1. a. The subclavian vein is a continuation of the axillary vein, beginning at the lateral border of the first rib and ending just medial to the sternocleidomastoid



  2. b. The external jugular vein, which lies in the posterior triangle of the neck, drains directly into the subclavian vein



  3. c. The right brachiocephalic vein is almost double the length of its left-sided counterpart



  4. d. Cannulation of the subclavian vein is best achieved by inserting the needle below the mid-point of the clavicle and aiming towards to the manubriosternal joint



  5. e. Cannulation of the internal jugular vein can be achieved by inserting the needle half way between the mastoid process and the sternal notch – in line with C6



Question 3




With regards to the cervical plexus:




  1. a. It is formed from the anterior rami of C1–C5



  2. b. The phrenic nerve originates from C3–C5 and travels down the neck behind the internal jugular vein



  3. c. Superficial branches supply structures to the back of the head and the skin at the front of the neck



  4. d. Deeper branches supply muscles of the neck, including the sternocleidomastoid and trapezius



  5. e. Cervical plexus blockade can lead to blockade of the cervical sympathetic chain, leading to Horner’s syndrome



Question 4




With regards to the pharynx, which of the following are true?




  1. a. The pharynx originates at the skull base, and extends to the level of the C4 vertebra



  2. b. The walls of the pharynx are coated in four different layers – mucous, fibrous, muscular and fascial



  3. c. The muscular coat consists of the constrictor muscles – superior, middle and inferior



  4. d. A pharyngeal pouch is formed between differences in the two functional components of the muscle



  5. e. Pharyngeal muscles involved in swallowing are supplied by the vagus and glossopharyngeal nerves



Question 5




The nasopharynx, oropharynx and laryngopharynx lie between the pharynx and larynx.




  1. a. The Eustachian tube opens into the nasopharynx



  2. b. Another name for the adenoids is the nasopharyngeal tonsils



  3. c. The oropharynx extends to the level of the epiglottis where it joins with the nasopharynx



  4. d. The laryngopharynx begins at the epiglottis and reaches the lower border of the cricoid cartilage



  5. e. The piriform fossae are recesses in the larynx that are often implicated in the accidental swallowing of fish bones



Question 6




The larynx is a complex structure containing a number of cartilages and ligaments.




  1. a. The thyroid cartilage has two plates which join to form the Adam’s apple



  2. b. The cricoid cartilage at the level of C6 articulates with the inferior horn of the thyroid cartilage



  3. c. The arytenoid cartilages are paired and each projects anteriorly as the vocal process



  4. d. The valleculae are depressions formed on either side of the epiglottis as it communicates with the tongue



  5. e. The corniculate and cuneiform cartilages lie in the aryepiglottic folds



Question 7




The membranes and ligaments within the larynx are as follows:




  1. a. The aryepiglottic fold gives rise to the false vocal cord



  2. b. The cricothryoid ligament is the recommended site for insertion of an emergency tracheostomy



  3. c. The thyrohyoid membrane contains the passage of the recurrent laryngeal nerve and the laryngeal artery



  4. d. The conus elasticus extends to form the vocal ligament as it attaches with the cricoid cartilage



  5. e. During a grade 1 laryngoscopy, a direct view should be obtained of the vallecula, epiglottis and the true vocal cords



Question 8




The cartilages and ligaments within the larynx are controlled by the intrinsic and extrinsic laryngeal muscles.




  1. a. The sternothyroid attaches to the thyroid cartilage and elevates the larynx



  2. b. The thyrohyoid attaches the thyroid cartilage to the hyoid bone and depresses the larynx



  3. c. The posterior cricoarytenoids cause abduction of the vocal cords



  4. d. The lateral cricoarytenoids cause closure of the glottis



  5. e. The transverse arytenoid is the only unpaired, intrinsic muscle



Question 9




With respect to the blood and nerve supply within the larynx:




  1. a. The arterial supply to the larynx is from the superior and inferior laryngeal arteries, which are branches of the superior thyroid artery



  2. b. Venous drainage empties into the internal jugular vein



  3. c. All muscles, except the sternothyroid, are supplied by the recurrent laryngeal nerve



  4. d. The recurrent laryngeal nerve and the superior laryngeal artery traverse the thyrohyoid membrane



  5. e. Lymphatic drainage from the larynx drains into the deep cervical chain



Question 10




The orbital cavity is frequently operated on under the provision of local anaesthetic blockade. It is therefore useful to have a good understanding of the structures held within the orbit and the globe.




  1. a. The orbit is pyramidal in shape



  2. b. The orbit contains two posterior openings: the superior and the inferior orbital fissures



  3. c. The globe is located anteriorly within the orbit and consists of three layers



  4. d. The vascular layer of the globe contains the choroid, the iris and the ciliary bodies



  5. e. Each retina is made up of approximately 120 million rods and 7 million cones



Question 11




Control of vision is determined by the following:




  1. a. Action of the ciliary muscle, which alters tension in the suspensory ligaments



  2. b. The smooth muscles fibres in the iris control the size of the pupil



  3. c. Ganglion cells in the retina give rise to axons, which gather at the optic disc and lead to the optic nerve



  4. d. Axons from the nasal half remain ipsilateral, whereas axons from the temporal half decussate at the optic chiasm



  5. e. The superior colliculus regulates movement of the eye



Question 12




Regarding the nerves of the orbit:




  1. a. CN III carries sympathetic fibres to constrict the pupil



  2. b. CN IV supplies the superior rectus muscle



  3. c. CN V is implicated in the corneal reflex



  4. d. CN VI supplies the lateral rectus muscle



  5. e. CN VII has an ophthalmic division, damage to which can lead to unilateral ptosis



Question 13




The mouth is the most frequently assessed component of an airway assessment. Variations in structures within the mouth can often pose significant difficulties in obtaining an adequate airway.




  1. a. On a grade 1 laryngoscopy view, one would be able to see the palatoglossal and the palatopharyngeal arches



  2. b. The tongue is located in the oral cavity and is controlled by actions of the intrinsic and extrinsic muscles



  3. c. The nerve supply to muscles of the tongue is primarily from cranial nerve IX, the hypoglossal nerve



  4. d. The anterior two-thirds of the tongue are innervated by the glossopharyngeal nerve



  5. e. Lingual nerve fibres pass into the facial nerve via the chorda tympani



Question 14




With regards to anatomical knowledge of the nose:




  1. a. The nasal cavity is divided by the nasal septum and contains a roof, a floor and two walls



  2. b. The cribiform plate of the ethmoid bone contributes to the roof of the nasal cavity



  3. c. The nasal septum makes up the medial wall and receives openings from the paranasal sinuses



  4. d. The lateral wall contains three conchae, anterior, middle and posterior, which act to increase the surface area



  5. e. Arterial supply to the nose is via the ophthalmic arteries and venous drainage is via the maxillary veins



Question 15




With regards to the thyroid gland:




  1. a. The thyroid gland is located at the level of C5–T1



  2. b. The thyroid isthmus overlies the trachea with two lobes on either side



  3. c. The acini within the gland contain colloid which stores thyroglobulin



  4. d. Parafollicular cells within the gland are responsible for the secretion of calcitriol



  5. e. Arterial supply to the thyroid is via the superior, middle and inferior thyroid arteries



Question 16




The parathyroid hormone is involved with calcium homeostasis.




  1. a. There are four parathyroid glands located in the upper poles of the thyroid gland



  2. b. Chief cells within the gland produce parathyroid hormone



  3. c. Parathyroid hormone is a polydisaccharide hormone that is stored in the parathyroid gland prior to being released into the bloodstream



  4. d. Increase in the level of parathyroid hormone causes an overall increase in serum calcium levels



  5. e. Calcitonin, produced by the parafollicular cells, augments the activity of parathyroid hormone in increasing serum calcium levels



Question 17




The following structures are present within the carotid sheath:




  1. a. Common carotid artery



  2. b. Internal carotid artery



  3. c. Internal jugular vein



  4. d. Vagus nerve



  5. e. Hypoglossal nerve



Question 18




The internal jugular vein lies:




  1. a. Anterolateral to the carotid artery



  2. b. Lateral to the vagus nerve



  3. c. Posterior to the thoracic duct



  4. d. Medial to the hypoglossal nerve



  5. e. Posterior to the sympathetic chain



Question 19




Complications associated with a deep cervical plexus block include:




  1. a. Total spinal



  2. b. Phrenic nerve palsy



  3. c. Horner’s syndrome



  4. d. Pneumothorax



  5. e. Recurrent laryngeal nerve palsy



Question 20




When performing a carotid endarterectomy under local anaesthesia, the following nerves need to be blocked:




  1. a. Supraclavicular nerve



  2. b. Trigeminal nerve



  3. c. Transverse cervical nerve



  4. d. Greater occipital nerve



  5. e. Lesser auricular nerve



Question 21




A maxillary nerve block can be administered in the pterygopalatine fossa. The following structures are present in the fossa:




  1. a. Maxillary nerve



  2. b. Maxillary artery



  3. c. Greater petrosal nerve



  4. d. Lingual nerve



  5. e. Lingual artery



Question 22




With regards to a sub-Tenon’s block:




  1. a. The Tenon’s capsule is a thin layer of connective tissue separating the globe from the orbital fat



  2. b. Local anaesthetic and aqueous iodine are applied to the eye prior to incision



  3. c. An incision is made in the lateral aspect of the conjunctiva



  4. d. The injection is made on the posterior aspect of the sclera



  5. e. A subconjuctival haemorrhage is seen in 50% of patients following insertion of the block



Question 23




The following complications are associated with a partial thyroidectomy:




  1. a. Haematoma



  2. b. Stridor



  3. c. Hypercalcaemia



  4. d. Recurrent laryngeal nerve palsy



  5. e. Thyroid storm



Question 24




Common preoperative features associated with a thyroid goitre include:




  1. a. Tracheomalacia



  2. b. Engorged nasopharyngeal vein



  3. c. Increased venous return



  4. d. Hoarse voice due to vocal cord abduction



  5. e. Stridor



Question 25




With regards to recurrent laryngeal nerve injury during thyroid surgery:




  1. a. The left is more prone to injury than the right



  2. b. Unilateral nerve injury will lead to hoarseness



  3. c. Bilateral nerve injury will lead to stridor



  4. d. Corrective surgery should be performed immediately



  5. e. Unilateral vocal cord paralysis will cause adduction of the cord



Question 26




This question concerns the structure of the trachea. Which of the following statements are true?




  1. a. It originates at the inferior end of the larynx, at approximately level C6



  2. b. It bifurcates into bronchioles at the level of the sternal angle, T5



  3. c. It has approximately 20 complete, circular, cartilaginous rings for support



  4. d. Is lined with pesudostratified ciliated columnar epithelium cells



  5. e. The trachealis muscle provides support to the cartilaginous rings



Question 27




The following question concerns the relationships of the trachea.




  1. a. The oesophagus lies posterior to the trachea



  2. b. The carotid sheath lies lateral to the trachea bilaterally



  3. c. The arch of the aorta runs posterior to the trachea



  4. d. The thyroid ima artery runs posterior to the trachea



  5. e. The inferior thyroid veins run lateral to the trachea bilaterally



Question 28




The following question is regarding the anatomy related to the insertion of a tracheostomy.




  1. a. A tracheostomy is normally placed superior to the thyroid gland



  2. b. A tracheostomy should be placed between the second and third tracheal rings



  3. c. The trachealis muscle should be divided longitudinally and retracted laterally



  4. d. The inferior thyroid artery is often encountered anterior to the thyroid and should be dissected clear and divided, to protect against bleeding



  5. e. The inferior thyroid veins often form a plexus on the anterior surface of the trachea and may lead to bleeding if divided



Question 29




With regards to tracheostomies:




  1. a. Dual antiplatelet therapy is an absolute contraindication to performing a tracheostomy



  2. b. Damage to the superior laryngeal nerve can lead to vocal cord paralysis



  3. c. The thyroid isthmus lies over the third and fourth tracheal rings



  4. d. A platelet count <50,000 µl–1 is an absolute contraindication for insertion of a percutaneous tracheostomy



  5. e. Wound infections are higher with surgical tracheostomies than with percutaneous tracheostomies



Question 30




Early complications of tracheostomy insertion may include:




  1. a. Pneumothorax



  2. b. Tracheal cartilage fracture



  3. c. Tracheomalacia



  4. d. Persistant tracheal stoma



  5. e. Bleeding from the innominate artery



Question 31




The intercostal space typically contains three muscles and a neurovascular bundle. The following question concerns the relations of these structures with the ribs.




  1. a. The most superficial muscle layer is the external intercostal muscle



  2. b. The deepest muscle layer is the internal intercostal muscle



  3. c. The intercostal neurovascular bundle runs posterior and inferior to the rib above



  4. d. The dorsal rami of T1–T11 form the intercostal nerve



  5. e. The arterial supply of the intercostal spaces comes from the anterior and posterior intercostals



Question 32




The following question is regarding the nerve supply to the intercostal spaces.




  1. a. There are 12 pairs of thoracic spinal nerves that supply the intercostal spaces



  2. b. Along its course, the intercostal nerve gives off a number of branches that supply the intercostal muscles and skin



  3. c. In supplying the skin in this manner, each intercostal nerve supplies its own dermatome



  4. d. A dermatome is the cutaneous area supplied by the ventral rami of a spinal nerve root



  5. e. Rami communicantes connect each intercostal nerve to the parasympathetic trunk



Question 33




Concerning the left main bronchus:




  1. a. It is more vertical than the right



  2. b. It passes inferior to the arch of the aorta



  3. c. It passes anterior to the oesophagus



  4. d. It passes posterior to the arch of the aorta



  5. e. It is more common for inhaled foreign bodies to become lodged within in it



Question 34




Concerning the bronchial tree:




  1. a. Each main bronchus is accompanied by pulmonary artery and vein, bronchial vessels, lymph vessels and nerves at the root of the lung



  2. b. Each main bronchus divides into secondary and then tertiary bronchi



  3. c. There are two secondary bronchi on the left and three on the right



  4. d. Each tertiary bronchus supplies a bronchopulmonary segment



  5. e. Oblique fissures separate the superior and inferior lobes bilaterally



Question 35




Concerning the surfaces of the lung:




  1. a. Each lung has three surfaces



  2. b. The cardiac surface is adjacent to the mediastinum



  3. c. The costal surface is adjacent to the sternum



  4. d. The diaphragmatic surface is adjacent to the diaphragm



  5. e. The root of the lung is on the mediastinal surface



Question 36




Concerning the borders of the lungs:




  1. a. Each lung has three borders



  2. b. Each lung has an apex



  3. c. The superior border is at the apex, which extends through the superior thoracic aperture



  4. d. The inferior border runs along the diaphragmatic surface



  5. e. The medial border runs along the mediastinum and forms the cardiac notch on the left



Question 37




With regards to the blood supply and lymph drainage of the lungs and bronchi:




  1. a. The right lung is supplied by two arteries and the left lung is supplied by one artery



  2. b. Each lung is supplied by a superior and corresponding lobar branches from the pulmonary arteries



  3. c. The bronchial arteries carry deoxygenated blood from the pulmonary arteries



  4. d. The superficial and deep lymphatic plexuses drain both of the lungs



  5. e. The deep lymphatic plexus drains directly into the thoracic duct



Question 38




The nerve supplies to the lungs and visceral pleura are closely related. The following question therefore considers the nerve supply to both organs:




  1. a. The pulmonary plexuses contain parasympathetic and sympathetic nerve fibres



  2. b. The parasympathetic nerve fibres arise from the vagus nerve (CN XI)



  3. c. The sympathetic fibres arise from the sympathetic trunk



  4. d. The plexuses are located at the roots of the lung



  5. e. Afferent fibres from the pleura and bronchi accompany the parasympathetic fibres



Question 39




Regarding the nerve supply to the lungs and surrounding structures, which of the following statements are correct?




  1. a. Parasympathetic innervation leads to bronchoconstriction



  2. b. Parasympathetic innervation leads to vasoconstriction



  3. c. Sympathetic innervation is secretomotor to the bronchial tree



  4. d. The nerve supplies to both lung and visceral pleura arise from intercostal and phrenic nerves



  5. e. Nerves to the parietal pleura arise from intercostal and phrenic nerves



Question 40




The pleurae are sacs, which line the inner surface of the thoracic cavity and form a lubricating layer over the lungs.




  1. a. The visceral pleura covers the surface of the lungs



  2. b. The parietal pleura covers the thoracic wall



  3. c. The parietal pleura is continuous with the abdominal peritoneum



  4. d. The parietal pleura is continuous with the cervical pleura



  5. e. The parietal and visceral pleurae are continuous at the root of the lung



Question 41




The thoracic diaphragm forms a dome-shaped, muscular division between the abdominal and thoracic cavities. The following statements relate to the function and structure of the diaphragm.




  1. a. The main function of the diaphragm is in expiration



  2. b. The main function of the intercostal muscles is in inspiration



  3. c. The diaphragm is lined by the visceral peritoneum



  4. d. The diaphragm is entirely muscular



  5. e. The diaphragm is anatomically continuous with the structures that pass through it between the thorax and abdomen



Question 42




Given that the diaphragm spans the floor of the thorax, there are a number of important attachments related to it. Which of the following statements are true?




  1. a. The anterior-most section of the muscular portion of the diaphragm attached to the xiphoid process forms two foramina laterally to it, between the sternal part and the costal part of the muscle



  2. b. The costal margins insert into the lower border of the ribs and costal cartilages 6–12



  3. c. Posteriorly, the diaphragm attaches to the lumbar vertebrae via the crura



  4. d. The right crus of the diaphragm inserts into the anterior surface of L1–L3



  5. e. The left crus of the diaphragm inserts in the anterior surface of L1–L2



Question 43




The diaphragm acts as the division between the abdomen and thorax. However, it allows the passage of a number of structures from thorax to abdomen and vice versa. Which of the following statements are true?




  1. a. The aortic hiatus is formed by the median arcuate ligament at the level of T12



  2. b. The oesophagus passes through the central muscular portion of the diaphragm



  3. c. With the oesophagus, the vagus and oesophageal branches of the left gastric vessels also pass through the oesophageal foramen



  4. d. The vena cava passes through the vena caval foramen at level T10



  5. e. With the vena cava, the right phrenic nerve also passes from thorax to abdomen



Question 44




The following question relates to the blood supply and lymphatic drainage of the diaphragm. This is conveniently divided into supply to the superior and inferior surfaces of the diaphragm.




  1. a. The arterial supply to the superior and inferior surfaces of the diaphragm is from the respective phrenic arteries, via the aorta



  2. b. The venous drainage of the superior and inferior surfaces of the diaphragm is via the respective phrenic veins, directly to the IVC



  3. c. The lymphatic drainage of the superior surface is to the diaphragmatic lymph nodes



  4. d. The lymphatic drainage of the inferior surface is to the superior lumbar lymph nodes



  5. e. There is no communication between the lymph plexuses between the superior and inferior surfaces of the diaphragm



Question 45




The following question relates to the innervation of the diaphragm.




  1. a. The entire motor supply of the diaphragm is from the phrenic nerve



  2. b. The sensory supply is from the phrenic nerve centrally and the intercostal nerves peripherally



  3. c. Both the sensory and motor supplies from the phrenic nerve arise from the ventral rami of C2–C5



  4. d. Commonly, following intra-abdominal surgery, pain is felt in the shoulder region, in the dermatome C5, due to referred pain from the phrenic nerve



  5. e. Intra-abdominal irritation peripherally on the diaphragm also refers pain to the shoulder due to the phrenic nerve



Question 46




The following question relates to the structure of the right atrium.




  1. a. It forms the base of the heart, as seen on the chest X-ray



  2. b. It receives the inferior and superior vena cavae and the coronary sinus



  3. c. The right atrium has a more muscular wall, when compared to the left atrium



  4. d. There are two parts to the internal wall of the atrium, divided by the crista terminalis



  5. e. The tricuspid valve is between the right atrium and right ventricle



Question 47




The following question is concerned with the structure of the left atrium.




  1. a. It forms the left and superior borders of the heart as viewed on chest X-ray



  2. b. It drains oxygenated blood via the pulmonary artery



  3. c. Is divided from the left ventricle by the semi-lunar mitral valve



  4. d. The cusps of the mitral valve are attached to the internal wall via the papillary muscle



  5. e. The left atrium is a common site for the formation of thrombus following myocardial infarction



Question 48




The following question relates to the structure of the right ventricle.




  1. a. It forms the anterior surface of the heart



  2. b. It pumps blood to the pulmonary arteries via the pulmonary valve



  3. c. The pulmonary valve is formed by three semi-lunar cusps



  4. d. The interventricular septum is formed as a muscular extension of the wall of the right ventricle



  5. e. The pulmonary valve is not affected by disease



Question 49




The following question relates to the structure of the left ventricle.




  1. a. It forms the entirety of the apex of the heart



  2. b. It pumps blood to the systemic circulation via the aortic valve



  3. c. The aortic valve has the same structure as the pulmonary valve



  4. d. The ascending aorta arises from its anterior part before arching posteriorly



  5. e. At each cusp, there is a sinus, which opens to a coronary artery



Question 50




The following question is regarding the surface anatomy of the heart.




  1. a. The contraction of the apex can be felt in the mid-clavicular line



  2. b. The left border of the heart runs from the second left costal cartilage (para-sternally) to the fifth left intercostal space, mid-clavicular line



  3. c. The superior border runs from the second costal cartilage on the right to the second costal cartilage on the left



  4. d. The inferior border runs from the fifth costal cartilage on the right, to the fifth intercostal space, mid-clavicular line on the left



  5. e. The right border runs from the third to sixth costal cartilages on the right



Question 51




The following question concerns the anatomical location and the positions for auscultation of the valves of the heart.




  1. a. The mitral valve can be auscultated over its anatomical position, posterior to the fourth left costal cartilage



  2. b. The aortic valve is usually auscultated over its anatomical position, posterior to the third left intercostal space.



  3. c. In aortic stenosis, a referred pulse can be auscultated over the left carotid artery



  4. d. The tricuspid valve can be auscultated over its anatomical position



  5. e. The pulmonary valve can be auscultated at the level of the fifth left costal cartilage, despite its anatomical position being at the level of the third left costal cartilage

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Oct 24, 2020 | Posted by in ANESTHESIA | Comments Off on Chapter 2a – Anatomy Questions
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