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Anatomy Best of Five

1) A 40 year old male presents to his GP with a two week history numbness and a burning
sensation on the lateral aspect of the left upper thigh. Examination reveals sensory loss over
the anterolateral thigh. Which one of the following nerves is most likely to be involved in this
patient?
1 ) femoral nerve
2 ) L2 nerve root
3 ) L3 nerve root
4 ) lateral cutaneous nerve of the thigh
5 ) obturator nerve

2) Which of the following statements are true of coronary artery anatomy?

1 ) Right bundle branch block in acute anterior myocardial infarction suggests obstruction
prior to the first septal branch of the left anterior descending coronary artery
2 ) the posterior descending artery is usually a branch of the circumflex artery
3 ) The sinus node is supplied by a branch of the right coronary in over 90% of subjects.
4 ) The AV node is supplied by the left anterior descending coronary artery.
5 ) The left main stem is about 4 cm long

3) A 40-year old lady presents to clinic complaining of an 18 month history of dorsoradial

wrist pain. She is a keen tennis player. On examination she has tenderness localized to the
dorsoradial aspect of the wrist and passive motion of the thumb causes crepitus in the same
region. Finkelstein’s test is positive. The likely diagnosis is:

1) Carpal tunnel syndrome

2) De quervain’s trenosynovitis
3) Golfer’s elbow
4) Tennis elbow
5) Ulna tunnel syndrome

4) Which of the following would be the result of a spinal lesion at the level of C8?
1) a reduced brachioradialis reflex
2) inability to abduct the shoulder
3) loss of sensation over the lateral aspect of the arm
4) winging of the scapula
5) weakness of finger flexion

5)Which of the following would be expected following distal occlusion of the posterior
cerebral artery?
1) cerebellar ataxia
2) contralateral hemiplegia
3) dysarthria
4) homonymous hemianopia
5) palatal palsy

6) A 73-year-old man presents with an abrupt onset of double vision and left leg weakness.
Examination shows weakness of abduction of the Rt eye, Rt-sided facial weakness affecting
upper and lower parts of the face. He also has a left hemiparesis. Where is the lesion?
1) left frontal lobe
2) left lateral medulla
3) right corpus striatum
4) right midbrain
5) right pons
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7) A 48-year-old female patient develops an acute, severe and isolated right C6 radiculopathy
affecting both the motor and sensory roots. She is examined in an EMG clinic 3 weeks after
the onset of symptoms. Which of the following statements is true?
1) Absent sensory nerve potentials would be expected on examination of the thumb
and index finger on the right.
2) A repeat examination 12 months later is likely to reveal rapidly recruited low
amplitude short duration motor units in the clinically involved muscle on EMG.
3) Fibrillation potentials would be expected in the right extensor carpi ulnaris and
extensor pollicis brevis.
4) Triceps tendon jerk is likely to be depressed or absent.
5) Voluntary motor unit activity may be absent in the right biceps.

8) An 80-year-old woman has a three month history of progressive numbness and

unsteadiness of her gait. On examination, there is a mild spastic paraparesis, with brisk knee
reflexes, ankle reflexes are present with reinforcement, extensor plantars, sensory loss in the
legs with a sensory level at T10, impaired joint position sense in the toes, and loss of
vibration sense below the iliac crests.Investigations were as follows:-

haemoglobin 12.0 g/dl

MCV 99 fl

What is the most likely diagnosis?

1) anterior spinal artery occlusion

2) dorsal meningioma
3) multiple sclerosis
4) subacute combined degeneration of the cord
5) tabes dorsalis

9) Which ONE of the following would be expected in a third nerve palsy?

1) Enophthalmos
2) Constricted pupil
3) Convergent strabismus
4) Increased lacrimation
5) Unreactive pupil to light

10) Which of the following regarding the anatomy of the heart is true?
1 ) The aortic valve is tricuspid.
2 ) The ascending aorta is entirely outside the pericardial sac.
3 ) The left atrial appendage is identified readily by transthoracic echocardiography.
4 ) The pulmonary trunk lies anterior to the ascending aorta.
5 ) The right atrium is posterior to the left atrium.

11) Which one of the following organs is in direct contact with the anterior surface of the left
kidney, without being separated from it by peritoneum?

1) Duodenum
2) Jejunum
3) Pancreas
4) Spleen
5) Stomach
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12) A 35 year old male is struck on the lateral aspect of his right knee by the bumper of a car
travelling at low velocity. On examination he is unable to dorsiflex the ankle, evert the foot
and extend the toes. There is loss of sensation of the dorsum of the foot. He is most likely to
have damaged which structure?

1) Common peroneal nerve

2) Deep peroneal nerve
3) Saphenous nerve
4) Sural nerve
5) Tibial nerve

13) Which of the following anatomical considerations is correct:

1 ) optic chiasm lesions characteristically produce a bitemporal hemianopia
2 ) central scotoma occurs early in papilloedema
3 ) in cortical blindness pupillary reactions are abnormal
4 ) optic tract lesions produce an ipsilateral homonymous hemianopia
5 ) opticokinetic nystagmus is found with bilateral infarction of the parieto-occipital lobes

14) A 16 year old male was presents to his GP with exertional breathlessness. The chest X-ray
reveals a lesion in the anterior mediastinum. Which one of the following is the most likely
cause for such an appearance?
1) Ascending aorta
2) Hilar lymph nodes
3) Left atrium
4) Oesophagus
5) Thymus gland

15) An 80 year old male presented with acute right-sided weakness. Examination revealed
minimal right facial weakness, impaired elevation of the right shoulder, with relatively
preserved right hand strength. There was global weakness in the right leg which appeared to
be maximal in the foot. Which of the following arteries is most likely to have been affected?

1) Anterior cerebral artery

2) Lenticulostriate artery
3) Middle cerebral artery
4) Posterior cerebral artery
5) Posterior communicating artery

16) A 35 year old man presents to A+E complaining of severe pain in his lower back after
lifting a heavy box at work. The pain radiates to his right buttock and thigh. He has had no
urinary symptoms. On examination he can straight leg raise to 90 degrees on the left side but
only to 30 degrees on the right. Sciatic stretch test is positive. He has difficulty plantarflexing
his right ankle and has abnormal sensation on the plantar aspect of the foot. His right ankle
reflex is absent but all other reflexes are normal. There is no other sensory disturbance. The
likely diagnosis is?

1) Cauda equina syndrome

2) L3/L4 disc prolapse
3) L4/L5 disc prolapse
4) L5/S1 disc prolapse
5) Old Shuerman’s disease
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17) A 40 year old male presents to his GP with a two week history numbness and a burning
sensation on the lateral aspect of the left upper thigh. Examination reveals sensory loss over
the anterolateral thigh. Which one of the following nerves is most likely to be involved in this
patient?

1) femoral nerve
2) L2 nerve root
3) L3 nerve root
4) lateral cutaneous nerve of the thigh
5) obturator nerve

18) A 60 year old woman presented with a small right pupil, right ptosis and impaired
sweating over the ipsilateral forehead. Sweating on the rest of the face was unaffected. Where
is the most likely site of this lesion?

1) cervical spinal cord

2) common carotid artery
3) hypothalamus
4) internal carotid artery
5) lateral medulla

19) An 80-year-old man previously fit and healthy presents with severe flinging movements
of the left upper limb, body and lower limbs.

Where is the neurological lesion?

1) Caudate nucleus
2) Globus pallidus
3) Ipsilateral thalamus
4) Substantia nigra
5) Subthalamic nucleus
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Anatomy Best of Five-Answers

1) 4
The pure sensory loss makes the diagnosis of Meralgia paraesthetica and is a consequence of
damage to the lateral cutaneous nerve of the thigh. It is usually a consequence of entrapment
at the lateral inguinal ligament or less likely, trauma, ischaemia or a retroperitoneal lesion.

2) 1

It is sometimes said that questions longer than 2 lines are usually false ... but not in this case.

The posterior descending artery is most often (85%) a branch of the right coronary artery. The
sinus node artery is a branch of the right coronary artery in 60% of cases. The AV node is
supplied from the posterior descending coronary artery. The left main stem is much shorted
than 4 cm!

3) 2

De Quervains’s tenosyunovitis is thought to be related to overuse and is common in golfers

and raquet sport players. Most affected are females 30-50 years old. Finkelsteins test (flexion
of the thumb into the palm, making a fist over the thumb and ulnar deviation of the wrist
causes pain in the first dorsal extensor complartment) is diagnostic.

4) 5
1 - brachioradialis is the "supinator" reflex and it is mediated by C5/6 2 - deltoid is supplied
by C5/6 3 - medial forearm and hand is affected. Lateral aspect of arm is C5 4 - this is caused
by paralysis of the long thoracic nerve to serratus anterior (C5,6,7)

5) 4
Distal (peripheral territory) posterior cerebral artery stroke, homonymous hemianopia (often
upper quadrantic), cortical blindness, verbal dyslexia without agraphia, hemivisual neglect,
visual hallucinations(Harrisons).

6) 5

The abducen nucleus is next to the facial nucleuu in pons. they commonly coexist in a pontine
CVA. Hemiparesis is also a common feature of pontine lesion.

7) 1

A difficult question. Thumb and index finger are within the C6 dermatome.

Extensor Pollicis Brevis and extensor carpi ulnaris are supplied by C7/8. Fibres from C7/8 are
also responsible for the triceps reflex. A pattern of rapidly recruited low amplitude short
duration motor units on the EMG would be considered to represent myopathic changes rather
than de-innervation.

8) 2
The presence of a sensory loss at T10 indicates a thoracic mylopathy. Subacute combined
degeneration of the cord is unlikely as Hb and MCV are normal. Anterior spinal artery
occlusion is unlikely as the history is progessive.
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9) 5

There is typically ptosis with a dilated unreactive pupil. Enophthalmos is seen in Horners
syndrome. There would be a dilated not constricted pupil and a divergent squint - affected eye
deviated 'down and out'. Increased lacrimation may be seen in VIIth palsy.

10) 1

The pulmonary trunk lies posterior to the aorta. The ascending aorta lies completely within
the pericardium as does the pulmonary trunk. The left atrium is the most posterior chamber of
the heart, the right atrium is just anterior and to the right of the left atrium. The left atrial
appendage is not readily seen on transthoracic echocardiography and requires
transoesophageal echocardiography.

11) 3

This is a really odd basic anatomy question which would be better suited to a surgical exam!
However the only retroperitoneal structure is the pancreas, the body of which is in direct
approximation to the anterior surface of the left kidney

12) 1

The common peroneal nerve supplies the muscles of the peroneal and anterior compartment
of the leg and sensation to the dorsum of the foot. The deep peroneal nerve is a division of the
common peroneal nerve and supplies only the muscles of the anterior compartment of the leg.

13) 1
2-Enlarged blind spot, 4-contralateral, 5-cerebellar lesions.

14) 5

Abnormalities of the anterior/superior mediastinum may relate to the thymus, thyroid. Inferior
or middle mediatinal masses relate to the aorta, lungs, hilar lymph nodes, oesophagus and
heart. Posterior mediatinal masses may relate to the nerves and vertebrae.
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15) 1

Unilateral occlusion (distal to Ant. Comm. origin) of Anterior Cerebral Artery produces
contralateral sensorimotor deficits mainly involving the lower extremity with sparing of face
and hands (think of the humunculus).
The Lateral Lenticulostriate artery is a branch of the middle cerebral artery. Occlusion causes
damage to the internal capsule resulting in contralateral hemiparesis and sensory deficit.
Speech may be affected (medial temporal lobe) as well as visual function (Meyer's loop: optic
radiations affected).

Middle Cerebral Artery: Occlusion at the stem (proximal segment) results in:

• Contralateral hemiplegia affecting face, arm, and leg (lesser).

• Homonymous hemianopia - Ipsilateral head/eye deviation.
• If on left: global aphasia.

Posterior cerebral artery: A variety of neurological syndromes including:-

• Pure hemisensory loss

• visual field loss- a variety
• Visual agnosia
• Disorders of reading (alexia, dyslexia) and more..........

16) 4

An L5/S1 disc prolapse affects the S1 nerve root causing sensory loss to the posterior calf and
the plantar surface of the foot; motor loss to gastrocnemius and soleus and loss of ankle jerk.

17) 4

The pure sensory loss makes the diagnosis of Meralgia paraesthetica and is a consequence of
damage to the lateral cutaneous nerve of the thigh. It is usually a consequence of entrapment
at the lateral inguinal ligament or less likely, trauma, ischaemia or a retroperitoneal lesion.

18) 4

Because the sympathetic plexus accompanying the internal carotid artery innervates sweat
glands only to the medial forehead, facial anhydrosis does not occur significantly with
postganglionic Horner syndrome

19) 5
The presence of severe flinging movements indicating hemibalistic movements. The site of
lesion is the contralateral subthalamic nucleus. The commonest cause is infarction. Usually
the flinging movements stop spontaneously in the next 4-8 weeks. Tetrabenazine is the
treatment of choice.