This question is purely testing your knowledge of the biliary tree anatomy. The Hepatopancreatic ampulla, otherwise known as the Ampulla of Vater, is formed from the pancreatic duct and the common bile duct. It opens into the second part of the duodenum.

The first lumbar vertebrae is level with the anterior end of the ninth rib. This level is also called the important transpyloric plane since the pylorus is at this level. Other important structures are also located at this level, they include; the fundus of the gall bladder, coeliac trunk, superior mesenteric artery, termination of spinal cord, and hilla of kidneys.

The Transpyloric plane, also known as Addison’s Plane, is an upper transverse line, located halfway between the jugular notch and the upper border of the pubic symphysis.

The plane in most cases cuts through the pylorus of the stomach, the tips of the ninth costal cartilage, and the lower border of the first lumbar vertebra.

The deep inguinal ring is located about 2.5 cm above the midpoint of the inguinal ligament.

The suprasternal notch (fossa jugular sternalis) is also known as the jugular notch. The Transpyloric plane, also known as Addison’s Plane, is an upper transverse line, located halfway between the jugular notch and the upper border of the pubic symphysis. The plane in most cases cuts through the pylorus of the stomach,

the tips of the ninth costal cartilages, and the lower border of the first lumbar vertebra While it is true that the transpyloric plane passes through the fundus of the gallbladder,

the fundus of the gallbladder is NOT at the midpoint between the suprasternal notch and pubic symphysis. It is on the same plane but it is more lateral nearer to the midclavicular line rather than the midsternal line.

Radial nerve(C5-T1)Motor to• Extensor muscles (forearm, wrist, fingers, thumb)• If damage leads to wrist dropSensory to• If damaged – Sensory loss is variable but always includes the dorsal aspect of the root of the thumb. Usually leads to loss to a small area between the dorsal aspect of 1st and 2nd metacarpals.

It is important to remember the key phrases for nerve damage during exam. There are certain phrases you need to memorize to relate them to specific nerve damage.ExamplesWrist drop – Radial nerveFoot drop – Either common peroneal nerve or sciatic nerveClaw hand – Ulnar nerveParaesthesia of thumb, index, and middle finger

– Median nerveNumbness on the superior aspect of the upper arm just below the shoulder joint – Axillary nerveFibular neck fracture – Common peroneal nerveFemur neck fracture or Acetabular fractures

– Sciatic nerveFracture of the humeral shaft – Likely Radial nerveFracture of the humeral neck

– Likely Axillary nerveMonteggia fracture – Radial nerve. Paraesthesia and impaired sensation in both hands (glove distribution) – Peripheral neuropathy.

Deep peroneal nerve (Deep fibular nerve) Motor functions The deep peroneal nerve innervates the muscles in the anterior compartment of the leg which are responsible for dorsiflexion of the foot at the ankle joint. Sensory functions The deep peroneal nerve innervates the webbed space of skin between the great toe (hallux) and the second toe.

Clinical relevance- The deep peroneal nerve can become entrapped or compressed during its course through the anterior compartment of the leg, and so a patient loses the ability to dorsiflex the foot. With unopposed plantarflexion, their foot drops. There are two main reasons why the deep fibular nerve could be compressed

. • The first is that the anterior leg muscles have been excessively used and so are compressing the nerve with the anterior compartment. The patient will experience pain in the anterior leg.

• The other common cause is tight-fitting shoes, compressing the nerve beneath the extensor retinaculum. This commonly occurs with wearing tight ski boots (referred to as ski boot syndrome).

The patient will experience pain in the dorsum of the foot.

This man has had a stroke affecting his temporal lobe. It is important to note that the most common cause of temporal lobe lesions is a cerebrovascular event (CVE). Several neural structures found in the temporal lobe are proposed to be involved in memory.

This also includes structures closely related to it such as the amygdala, the hippocampus, and the rhinal cortex in the temporal lobe. Once you know that the temporal lobe is affected, you will be able to answer the question.

The optic radiation passes through the temporal lobes. Damage to this can cause an upper homonymous quadrantanopias.

The skin at the medial malleolus drains into inguinal lymph nodes.

The weakness and lump at the distal arm are characteristic of a biceps tendon rupture. There are two types of biceps tendon rupture which are proximal and distal.

Thankfully, this question does not require you to differentiate the two.

Proximal biceps tendon rupture

• Ruptures of the proximal biceps tendon make up nearly all biceps ruptures

• Presents with the biceps muscle bunches up in the distal arm, causing the characteristic ‘Popeye muscle’ appearance.

There is minimal loss of function. Distal biceps tendon rupture

• Distal biceps tendon rupture is usually caused by a single traumatic event involving flexion against resistance, with the elbow at a right angle.

• Presents with a sudden tearing sensation resulting in a painful swollen elbow with weakness of flexion and supination.

This landmark is especially important when attempting to insert a chest drain. Always look for the safe triangle when inserting chest drains. Insert the drain in an area anterior to the mid-axillary line, posterior to the pectoral groove, and above the 5th intercostal space.

This is called a peroneal strike. A peroneal strike is a temporarily disabling blow to the common peroneal nerve of the leg,

just above the knee which causes a temporary loss of motor control of the leg, accompanied by numbness and a painful tingling sensation from the point of impact down the leg, usually lasting anywhere from 30 seconds to 5 minutes in duration.

Ulnar nerve (C8-T1) Sensory loss is over the little finger and a variable area of the ring finger (palmar & dorsal) This is the nerve of finger abduction and adduction. Injury level determines the severity of the claw deformity. In a distal lesion of the ulnar nerve,

there will be more clawing of the 4th and 5th fingers compared with a proximal, more complete lesion at the elbow.

Patients with central retinal artery occlusion have a sudden painless loss of vision, usually within the initial visual acuity of counting fingers or worse. Urgent management is required. The short episodes of previous vision loss are termed amaurosis fugax.

This temporary painless type of vision loss produces loss of vision in up to 10% of patients with central artery occlusion.

Amaurosis fugax is usually caused by emboli coming from atherosclerotic carotid artery resulting in a fleeting loss of vision when the emboli pass through the retinal circulation. Any temporary reduction in the retinal artery blood flow would cause retinal hypoxia which includes any emboli arising from vasculature preceding the retinal artery. The anatomy of the arterial supply of the eye is complicated. It is provided by several branches of the ophthalmic artery, which derives from the internal carotid artery. These branches include the central retinal artery, the short and long posterior ciliary arteries, and the anterior ciliary arteries. The retina is mainly supplied by the central retinal artery and its branches which is a site of emboli.

The other arteries are less likely to be involved as they present with additional symptoms.

• Anterior and middle cerebral artery occlusions have features of contralateral hemiparesis and sensory loss.

• Posterior inferior cerebellar artery has features of ipsilateral facial pain and temperature loss, contralateral limb/torso pain and temperature loss, ataxia, and nystagmus

• Anterior communicating artery is a common site for brain aneurysms and if large enough to compress the optic chiasm visual defects such as bitemporal hemianopsia may occur Key points to remember

• Amaurosis fugax is the temporary loss of vision due most commonly to ischaemia

• Embolism is the most common cause of central retinal artery occlusion with the major source of this being atherosclerotic plaques of the carotid artery (as opposed to transient ischaemic attacks (TIA) involving the cerebral hemispheres where emboli usually originate from heart disease instead of carotid stenosis).

The Common Bile Duct lies in close relation to the head of the pancreas. The initial presentation on about 70% of patients with carcinoma of the head of the pancreas is jaundice due to obstruction of the CBD by the tumour.

The Saphenous nerve is the largest cutaneous branch of the femoral nerve and is a strictly sensory nerve with no motor functions. Surgery for varicose veins, saphenous vein cutdown, and orthopedic surgery can result in damage to the saphenous nerve, resulting in loss of cutaneous sensation in the medial leg.

It can also be damaged during vein harvest for bypass surgery and trocar placement during knee arthroscopy. Remember:

• Loss of sensation in the medial foot: Saphenous Nerve

• Loss of sensation in the lateral foot: Sural nerve

• Foot drop: Common peroneal nerve.

The Inferior Alveolar Nerve is a branch of the Mandibular nerve, which is the third branch of the Trigeminal Nerve. The nerve supplies sensation to the lower teeth and via the mental nerve, sensation to the chin and lower lip. Damage can occur commonly during dental procedures especially wisdom teeth removal as well as due to mandibular trauma.

This is called a peroneal strike. A peroneal strike is a temporarily disabling blow to the common peroneal nerve of the leg, just above the knee which causes a temporary loss of motor control of the leg, accompanied by numbness and a painful tingling sensation from the point of impact down the leg, usually lasting anywhere from 30 seconds to 5 minutes in duration.

Hand weakness involves either the median nerve which has contributions from C5-T1 or the ulnar nerve which originates from the C8-T1 nerve roots. Remember, a C8 vertebrae does not exist so the option for C8/T1 is wrong. There are seven cervical vertebrae (C1-C7) and a total of eight cervical nerves C1-C8.

All cervical nerves except C8 emerge above their corresponding vertebrae, while the C8 nerve emerges below the C7 vertebra which is between C7 and T1 vertebrae. When you request a cervical X-ray for any severe injury of the neck, you would like the film to extend up to C7/T1 as you would be able to see the cervical vertebrae (C1-C7). This applies to any trauma including road traffic accidents.

The patient should not try to move her neck and she should continue to have the cervical collar and immobilization of the neck until the cervical X-ray is performed to rule out cervical fractures.

In this case, there should be at least 3 X-ray views taken.

• AP cervical spine view which shows the pedicles, facets, and lateral masses

• Lateral cervical spine view

• Open-mouth odontoid view also called the peg view would demonstrate peg fractures In some cases where the patient’s neck is short, the X-ray film would not show the C7/T1 junction.

The radiographers would then ask for a swimmer's lateral view.

This involves repositioning the patient in such a way that the arm closest to the sensor is placed above the patient’s head much like a swimming position. This would likely provide a clear visualization of the C7/T1 junction.

If again, this does not capture that junction, then we would need to request a CT scan to rule out fractures.

The trochlear nerve innervates the superior oblique muscle. It only causes diplopia on downgaze like looking downwards to walk. This is a high-yield question in exam. Please remember the nerves involving the eye and how they present.

NERVES INVOLVING THE EYE Functions CN III – Oculomotor nerve

• Controls most of the eye muscle

• Constriction of pupil

• Levator palpebrae superioris CN IV – Trochlear nerve

• Innervates a single muscle – Superior oblique CN VI – Abducens nerve

• Lateral rectus muscle Palsies The simple method to remember for the exam is: CN III – Oculomotor nerve

• Will have features of either ptosis and/or a dilated pupil on the nerve on the same side as the affected eye

• Mnemonic: The letter “O” for oculomotor which with a good imagination can represent a dilated pupil CN IV – Trochlear nerve

• Diplopia on downward gaze

• If looks right and sees double, then the lesion is on the left (Opposite to gaze) CN VI – Abducens nerve

• If the looks left and see double, then the lesion is on the left. (same side as gaze) Another mnemonic is: LR6(SO4)O3

• Lateral rectus – 6th Nerve

• Superior oblique – 4th Nerve

• Others – 3rd Nerve.

His right eye is unable to abduct thus he sees double. The nerve involved here would be the right abducens nerve.

Unfortunately, this is just something that you have to memorize Some other important clinchers for anatomy questions:

Ulnar nerve (C8-T1) Sensory loss is over the little finger and a variable area of the ring finger (palmar & dorsal) This is the nerve of finger abduction and adduction. Injury level determines severity of the claw deformity.

In a distal lesion of the ulnar nerve, there will be more clawing of the 4th and 5th fingers compared with a proximal, more complete lesion at the elbow. The short saphenous vein is the only one which travels on the lateral aspect of the ankle. Note that the great or long saphenous vein travels on the medial aspect of the ankle.

The left anterior descending (LAD, interventricular artery appears to be a direct continuation of the left coronary artery which descends into the anterior interventricular groove. The skin at the medial malleolus drains into inguinal lymph nodes. The first lumbar vertebra is level with the anterior end of the ninth rib. This level is also called the important transpyloric plane, since the pylorus of the stomach is at this level. The deep inguinal ring is located about 2.5 cm above the midpoint of the inguinal ligament. Full extension of right thumb is achieved by extensor pollicis longus The fundus of the gall-bladder approaches the surface behind the anterior end of the ninth right costal cartilage close to the lateral margin of the Rectus abdominis. The extensor digitorum communis extends the phalages, then the wrist, and finally the elbow. It tends to separate the fingers as it extends them. The suprasternal notch (fossa jugularis sternalis) is also known as the jugular notch The extensor pollicis brevis extends the thumb at the metacarpophalangeal joint. Whenever you see the word “foot drop” or “unable to dorsiflex: pick the peroneal nerve. Radial nerve (C5-T1) Motor to • Extensor muscles (forearm, wrist, fingers, thumb) • If damaged –

leads to wrist drop Sensory to

• If damaged – Sensory loss is variable, but always includes the dorsal aspect of the root of the thumb.

Usually leads to loss to a small area between the dorsal aspect of 1st and 2nd metacarpals. Facial nerve lesion leads to facial weakness and loss of taste sensation in the anterior two-thirds of the tongue. Vagus nerve lesion results in weak cough, vocal cord paralysis with dysphonia. There is also parasympathetic loss of innervation to respiratory, gastrointestinal, and cardiovascular systems.

Trigeminal nerve lesion presents with signs depending upon the level of the lesion. Usually, there is weakness of muscles of mastication, jaw deviates to the side of weak pterygoid muscle and there is also loss of sensation on the face.

Glossopharyngeal nerve lesion presents with loss of gag reflex, loss of taste sensation from the posterior third of the tongue, and loss of general sensation from the posterior pharynx, tonsils, and soft palate. The hypoglossal nerve is the twelfth cranial nerve XII and innervates muscles of the tongue.

The left anterior descending (LAD, interventricular) artery appears to be a direct continuation of the left coronary artery which descends into the anterior interventricular groove.

To choose the correct answer, one should remember the maxillary nerve and the structures that it supplies. The maxillary nerve carries sensory information from the lower eyelid and cheek, the nares and upper lip, the upper teeth and gums, the nasal mucosa,

the palate and roof of the pharynx, the maxillary, ethmoid and sphenoid sinuses, and parts of the meninges. The maxillary division of the facial nerve innervates both the cheek and the palate (along with the upper lip, upper teeth, gums, nasal mucosa, roof of the pharynx, and the maxillary ethmoid and sphenoid sinuses).

But pay attention, the question asks about which MUCOSA the maxillary branch of the trigeminal nerve innervates so the best answer will therefore be the palate as it is a mucous membrane.

The extensor digitorum communis extends the phalanges, then the wrist, and finally the elbow. It tends to separate the fingers as it extends them.

When inserting a chest drain, one needs to be aware of the intercostal neurovascular bundle. This is located at the inferior aspects of the ribs. The intercostal neurovascular bundle contains structures in a specific order which can be remembered as “VAN”.

This stands for • V – Vein • A – Artery • N – Nerve This order is from top to bottom The options in this question only have one of the structures of the intercostal neurovascular bundle which is the intercostal artery.

Hence that is the answer. Having this knowledge of the location of the intercostal neurovascular bundle would help you remember to insert the needle directly above the upper margin of the relevant rib.

Chest drain Insertion technique Chest insertion should be performed within the “safe triangle” In the exam, it is important to remember the borders of the “Safe triangle” which is used in clinical practice for chest drain insertions.

It is bounded anteriorly by the pectoralis major, posteriorly by latissimus dorsi, inferiorly by the fifth intercostal space, and superiorly by the axilla. By inserting at the safe triangle, we avoid major vessels and muscles

. It is important to note that the intercostal vessels and nerves run below the inferior border of the ribs. Thus, the drain track should be directed over the top of the lower rib to avoid the intercostal vessels lying below each rib.

The C8 nerve root exits the spinal cord at the C7-T1 spinal segment. If the C8 nerve becomes compressed or irritated for any reason, then C8 radiculopathy will occur. Symptoms of a C8 radiculopathy include weakness of thumb extension and wrist ulnar deviation. Paresthesias in the little finger is also a finding in C8 radiculopathy. The test to be performed to identify C8 radiculopathy is to have the patient hold their extended fingers together against the examiner’s attempts to open the fingers.

It is important in this question to differentiate between pure ulnar neuropathy and C8-T1 radiculopathies.

The ulnar nerve provides sensation to the fourth and fifth fingers and medial border of the hand. The ulnar nerve innervates all intrinsic hand muscles, except the abductor and flexor pollicis brevis, opponens pllicis, and lateral two lumbricals, which are innervated by C8 and T1 via the median nerve.

By examining these five muscles, one can clinically differentiate cubital tunnel syndrome from C8-T1 radiculopathies. The ulnar nerve does not provide sensation to the medial forearm,

which is innervated by the medial antebrachial cutaneous nerve which is supplied by C8 and T1 via the medial cord of the brachial plexus.

Therefore, an ulnar lesion at the elbow which is a common site of compression or trauma would result in anaesthesia of the ulnar hand and fingers but not the forearm.

The accessory nerve is a cranial nerve that controls the sternocleidomastoid and trapezius muscles. Injury to the spinal accessory nerve can cause an accessory nerve disorder or spinal accessory nerve palsy, which results in diminished or absent function of the sternocleidomastoid muscle and upper portion of the trapezius muscle. 

The superficial inguinal lymph nodes receive afferent lymphatic vessels from the scrotum.

For the exam, know these three general areas of infarct. Cerebral infarct

• Contralateral sensory loss/hemiplegia, dysphasia, homonymous hemianopia.

Brainstem infarct

• Quadriplegia, locked-in syndrome, vertigo, diplopia Lacunar infarcts

• Ataxic hemiparesis, pure motor loss, pure sensory loss, sensorimotor loss, dysarthria Although this patient is having difficulty speaking, the most likely area of fact is still the internal capsule (which is part of the lacunes).

Gliomas are tumours arising from glial cells and may occur in the spinal cord or the brain.

The dura mater, which is a thick membrane of the outermost three layers of the meninges that surround the brain and

spinal cord would need to be opened for the surgery to take place.

The lymphatic drainage of the ovaries is into the para-aortic nodes.

Full extension of the right thumb is achieved by extensor pollicis longus.

Prepatellar bursa The prepatellar bursa is a frontal bursa of the knee joint. It is a superficial bursa with a thin synovial lining located between the skin and the patella. Prepatellar bursitis classically occurred in housemaids, hence the nickname ‘housemaid’s knee’.

It is commonly seen in people who have knees such as plumbers. Friction caused by repeated kneeling can cause it.

It is a common cause of swelling and pain over the anterior inferior patella.

Symptoms

• Redness

• Inability to flex the knee

• Pain and swelling are localized over the site of the bursa (e.g. below the patella) Rest usually relieves symptoms.

The anterior 2/3 of the tongue is supplied by the submandibular lymph nodes. The posterior 1/3 of the tongue is supplied by the jugulo-omohyoid lymph nodes The tip of the tongue is supplied by the submental lymphnodes.

The posterior oropharynx predominantly drains into the jugular nodes. The jugular nodes are also known as the deep cervical nodes though that is an outdated terminology.

Peroneal nerve injury • The common peroneal nerve crosses the fibular neck and is susceptible to injury from a fibular neck fracture, the pressure of a splint, or during surgical repair. • Peroneal nerve injury may result in foot drop and sensation abnormalities.

It is important to understand the nerve root innervation of the common reflexes. This is not always an exact science, and there may be slight variations depending on which textbook you read. Damage to the associated nerves can also lead to diminished reflexes.

REFLEX ACTION INNERVATION Anal (anal wink) reflex Contraction of external anal sphincter muscle on stroking the skin around the anus S2-S4 Ankle reflex The Achilles tendon is struck causing plantar flexion of the foot S1&S2 Sciatic nerve Knee (patella) reflex The patellar ligament is struck causing contraction of the quadriceps muscle L3 & L4 Femoral nerve Biceps reflex

The biceps brachii tendon is struck causing flexion at the elbow C5 & C6 Musculocutaneous nerve Brachioradialis (supinator reflex)

The brachioradialis is struck causing wrist extension with radial deviation C6 & C7 Radial nerve Triceps reflex The triceps brachii tendon is struck causing extension C6 & C7 Radial nerve.

The hypoglossal nerve is the twelfth cranial nerve XII and innervates muscles of the tongue. The following are the common causes of this nerve injury: a. Lower motor neuron lesions – Polio, syringomyelia b. Stroke c. Bulbar Palsy d. Neck trauma e.

Surgery – Carotid endarterectomy Symptoms often show deviation of the tongue towards the paralyzed side when it is stuck out. This is because of the weaker genioglossal muscle. Other lesions: Facial nerve lesion leads to facial weakness and loss of taste sensation in the anterior two third of the tongue. Vagus nerve lesion results in weak cough, vocal cord paralysis with dysphonia.

There is also parasympathetic loss of innervation to respiratory, gastrointestinal, and cardiovascular systems.

Trigeminal nerve lesion presents with loss of gag reflex, loss of taste sensation from the posterior third of the tongue, and loss of general sensation from the posterior pharynx, tonsils, and soft palate.

The fundus of the gallbladder approaches the surface behind the anterior end of the ninth right costal cartilage close to the lateral margin of the Rectus abdominis.

The correct answer is Flexor digitorum superficialis because it causes flexion at metacarpophalangeal joints (MCP), as well as at the interphalangeal joint (IP) There is no doubt that flexor pollicis brevis flexes the MCP joint of thumb but here we do not have that as an option. Moreover, the patient is also unable to flex the proximal interphalangeal joints of her left hand.

Hence, flexor digitorum superficialis flexes both, the MCP JOINT as well as the IP JOINTS of the hand so the best answer here is flexor digitorum superficialis. Flexor digitorum profundus causes flexion of the distal interphalangeal joint (DIP), therefore, this is not correct.

Lumbrical muscles are intrinsic muscles of the hand that simultaneously flex the metacarpophalangeal joints and extend the interphalangeal joints. The flexor digiti minimi is a hypothenar muscle that causes flexion of the 5th digit (the little finger) at the metacarpophalangeal joint.

The dorsal interosseous muscles arise between the metacarpal bones and are abductors of the fingers.

The short saphenous vein is the only one which travels on the lateral aspect of the ankle. Note that the great or long saphenous vein travels on the medial aspect of the ankle.

The trochlear nerve innervates the superior oblique muscle. It only causes diplopia on downgaze like looking downwards to walk. It is a trochlear nerve lesion on the left side because he sees double when looking on the right side. This is a high-yield question in exam. Please remember the nerves involving the eye and how they present.

The lymphatic drainage of the testes is into the para-aortic nodes. Both the male and female gonads drain into the para-aortic nodes. Remember, the testes drain into the para-aortic node but the scrotum drains into the superficial inguinal nodes.

Posterior gastric ulcers arising from the fundus or body of the stomach erode into the lesser sac behind the stomach. The lesser sac is a potential space and is less effective in sealing off the perforation.

This results in the accumulation of gastric contents and pus resulting in the formation of an abscess which will then pass into the peritoneal cavity through the Foramen of Winslow leading to generalized peritonitis. In contrast, posterior perforation of pyloric and duodenal ulcers results in a retroperitoneal abscess.

L4 is at the level of the iliac crest. Most anaesthetist would know this as the supracristal plane

which is the highest point of the iliac crest typically sits at the level of L4 vertebrae which is a landmark for identification of L4/5 where a lumbar puncture can be performed.

The extensor pollicis brevis extends the thumb at the metacarpophalangeal joint.

The nerve involved here would be the right oculomotor nerve. This is a high-yield question in exam. Please remember the nerves involving the eye and how they present.

Please see Q-25 for Chest Drain Insertion Technique

A T1 lesion presents with movement disorders that affect the intrinsic muscles of the hand such as adduction or abduction of the digits. Paraesthesia and pain can also occur along the affected nerve. The cervical spine is comprised of seven vertebrae only.

A C8 vertebral injury is physically impossible and hence cannot be the right answer. A C8 nerve root lesion presents with abnormalities of thumb movement primarily, as well as an inability to extend the elbow against resistance.

T1 radiculopathy has similarities in clinical findings to C8 radiculopathy, so be thankful that the option was C8 vertebral injury and not nerve root injury. The ulnar nerve originates from the C8-T1 nerve roots. Ulnar nerve injury leads to the classic ‘claw hand’ deformity.

Since the ulnar nerve provides sensory innervation to the medial side of the hand, the fifth digit, and the medial half of the fourth digit, injury to it will cause loss of sensation or paraesthesia in those areas.

A C6 lesion affects the sensation of the thumb, flexion of the elbow, and rotation of the forearm. It usually occurs in conjunction with C5 injury. One may see this during the delivery of a baby which is known as Erb’s palsy.

Here are some easy points to remember regarding motor function for cervical roots • Flex elbow – C5 • Extend wrist – C6 • Extend elbow – C7 • Flex fingers – C8 • Adduct and abduct fingers – T1 Try to do the above sequence like a strange dance to help you memorize it.

The key is B. Superficial inguinal lymph nodes

Ans. The key is the B. Prepatellar bursa. [A fall onto the knee can damage the prepatellar bursa. This usually causes bleeding into the bursa sac causing swollen painful knees. Prepatellar bursitis that is caused by an injury will usually go away on its own.

The body will absorb the blood in the bursa over several weeks, and the bursa should return to normal. If swelling in the bursa is causing a slow recovery, a needle may be inserted to drain the blood and speed up the process.

There is a slight risk of infection in putting a needle into the bursa].

The key is C.Submandibular lymph nodes

Ans. The key is A. Short saphenous vein. [short saphenous vein travels lateral aspect of the ankle while great or long saphenous vein travels medial aspect of ankle].

The key is A. Subarcnoid

The key is D. Inguinal lymph node

Ans. The given key is the D. Transpyloric plane. [The termination of the spinal cord is between L1 and L2 (variable between people).

L1 landmark- duodenum first part,

superior mesenteric artery,

hila of both kidneys,

upper border of the pancreas,

splenic artery, pylorus, and

fundus of gall bladder].

The key is D. Transpyloric plane

The key is A. Fundus of the gallbladder

The key is D. Deep inguinal ring.

The key is B. Chest drain insertion

The key is B. Left anterior descending artery

Ans. The key is D. Extensor pollicis brevis. [Action of extensor pollicis brevis is an extension of thumb at the metacarpophalangeal joint. Extensor pollicis longus extends the terminal phalanx of the thumb].

The key is D. Inguinal lymph nodes

Ans. The key is C. Extensor digitorum. [The extensor digitorum extends the phalanges, then the wrist, and finally the elbow. It acts principally on the proximal phalanges].

The key is C. Lesser sac

The key is D. Inguinal lymph nodes

The key is C. Linea alba

The key is D. Intercostal muscles

The key is C. Duramater

The key is B. Cricoid cartilage. [Incision for tracheostomy is done which goes down from cricoid cartilage].

Ans. The key is A. C7/T1.

Ans. The key is D. Inguinal lymph nodes. [Anal canal below the pectinate line is drained into superficial inguinal lymph nodes].

The key is C. Circumflex artery

The key is D. Deep cervical lymph node

The key is D. Internal oblique and transverse abdominal

The key is B. Left ant descending artery

The key is D. External and internal oblique muscles

The key is C. Lingual nerve

Ans. The key is the B. Iliac crest. [Lumbar puncture is done in the L3-L4 interspace by palpating the right and left posterior superior spines of the iliac crest and moving the fingers medially towards the spine].

Ans. The key is C. Temporal bone. [The temporal bone consists of four parts— the squamous, mastoid, petrous, and tympanic parts].

D. Short sephanous vein. [Short saphenous vein courses through the lateral side of the leg while long or great saphenous vein courses medially].

The key is D. Popliteal vein