MRCOG-1 MARCH 2014 Edition

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1. Which of the following is not a branch of the pudendal nerve?

Perineal nerve.
Dorsal nerve of the penis.
Inferior rectal nerve.
Genitofemoral nerve. Correct Answer
Posterior scrotal nerve
The pudendal nerve is derived from the second to fourth sacral segments. It courses through five regions:
the sacral region where the three sacral segments fuse; gluteal region; pudendal canal which begins at the
posterior border of the ischiorectal fossa and ends at the posterior edge of the urogenital diaphragm; the
deep perineal space which is the fascial space between the superior and inferior fasciae of the urogenital
diaphragm; and the superficial perineal space.

2. Which of the following nerve roots, if compressed by a herniated disc, would result in a diminished knee
jerk?

L2
L4 Correct Answer
L5
S1
S2
L3L4 nerve root compression results in a diminished knee jerk.

3. What epithelial type would you expect to find in the area labelled C?
 Simple columnar Correct Answer
Simple cuboidal
Simple squamous
Stratified columnar
Stratified squamous
This picture is of a healthy cervix.

It is extremely important to have a good knowledge of the anatomy of the cervix both for taking swabs and
taking cervical smears.
The area labelled C is simple columnar epithelium, the border of which, B, forms the transformation zone
(the border between the columnar epithelium and squamous epithelium). It is this area that needs to be
sampled when taking a cervical smear.
A is stratified squamous epithelium and forms the majority of visible cervix when a speculum examination is
performed and D is the cervical os.
Stratified epithelium is different from 'simple' in that it is made up of many layers and tends to be found in
areas of the body where mechanical support is required. For that reason it is a feature more typically
associated with squamous epithelium.

4. A 76-year-old lady presents with painless, frank haematuria. A cystoscopy identifies a bladder carcinoma.
You organise a CT for tumour [Link] which lymph nodes are metastases most likely?

External iliac Correct Answer

Deep inguinal
Para aortic
Popliteal
Superficial inguinal
The lymphatic vessels leave the superior surface of the bladder and drain into the external iliac lymph
nodes.
The fundus of the bladder drains into the internal iliac nodes, and some vessels may drain into the common
iliac or sacral nodes so these are possible areas for lymphadenopathy.
However, for malignancy or infection of the bladder, lymphadenopathy is most common in the external and
internal iliac nodes.

5. A 17-year-old girl presents to you six weeks pregnant. After discussion with her family and yourself she
has decided that she would like a termination. She is terrified of having an operation and requests a medical
[Link] explain the process and give her mifepristone. What is the action of this drug?

Imitates GnRH
Imitates oxytocin
Inhibits HCG
Inhibits the action of oestrogen
Inhibits the action of progesterone Correct Answer

Mifepristone inhibits the action of progesterone by binding to and blocking progesterone receptors.

It can be used as a medical alternative to surgical termination up to five weeks after conception. It is given
as a single dose orally, and is followed 48 hours later by a prostaglandin pessary (gemeprost) to induce
uterine contractions and soften the cervix.
Progesterone is secreted by the corpus luteum in early pregnancy, acting to inhibit uterine motility and
maintain the endometrium after implantation. By blocking the action of progesterone, the endometrium
begins to degenerate, menstruation occurs and the embryo sloughs off with the uterine lining.

6. What is the average length of the newborn in the United Kingdom?

40 cm
42 cm
46 cm
50 cm Correct Answer
54 cm
This is a basic neonatology topic knowledge of which is required for the examination. The average newborn:

Is 50 cm long
Has an average weight of 3.5 kilos and
Average head circumference of 35 cm.

7. Which one of the following structures is the termination of the round ligament?

Deep inguinal ring

Labia majora Correct Answer
Labia minora
Lateral vaginal walls
Superficial inguinal ring

The round ligament arises out of the uterine fundus and inferior and anterior to the fallopian tube.
It runs through the broad ligament, passing over the external iliac vessels and the psoas muscle before
passing through the inguinal canal and fanning out into fibres to form the labia majora.
Clinical relevance: when performing an abdominal hysterectomy, the round ligaments are clamped and
ligated whilst in the broad ligament.

8. Into which of the following blood vessels does the left ovarian vein drain?

Anastomosis with the uterine vein

Inferior vena cava
Left renal vein Correct Answer
Right renal vein
Superior mesenteric vein

The ovarian arteries come directly off the abdominal aorta, however the drainage of the ovaries is different
for each one.
The right ovarian vein drains directly back into the inferior vena cava, whilst the left one drains into the left
renal vein, and then onto the inferior vena cava.
It is the ovarian arteries that form an anastomosis with uterine artery.
The superior mesenteric vein has a role in draining the bowel.

9. What is the lymphatic drainage of the ovaries?

Common iliac nodes

External iliac nodes
Internal iliac nodes
Para-aortic nodes Correct Answer
Sacral nodes

Knowledge of the drainage of the pelvic organs is important for predicting the pattern of metastases.
The ovaries are supplied by the ovarian arteries which come directly off the abdominal aorta, and is
consequently drained by the para-aortic nodes.
Similarly, male gonads are also drained by the para-aortic nodes.
External iliac nodes drain the bladder.

10. From which embryological structure is the round ligament of the uterus derived?

Cloaca
Gubernaculum Correct Answer
Mullerian duct
Urachus
Wolffian duct

The gubernacula are paired mesenchymal structures.

In men, the lower part becomes the scrotal ligament, with the upper part degenerating, In women, the upper
part becomes the suspensory ligament of the ovary, whilst the lower part become the round ligament.
The wolffian duct degenerates in females but contributes to the suspensory ligaments.
The mullerian ducts fuse to form the uterus, cervix and vagina.
The bladder is formed from the cloaca, whilst the urachus forms the median umbilical ligament.
11. Which vessels anastomose with the vaginal arteries to form the blood supply to the lower third of the
vagina?

Ovarian artery
Spiral arteries
Terminal branches of internal pudendal artery Correct Answer
Uterine artery
Vaginal branch of uterine artery
The internal pudendal artery branches from the internal iliac artery supplying the blood to the external
genitalia, and also giving rise to the peroneal and inferior rectal arteries.

12. Which paired structures contain the uterine arteries and veins?

Broad ligaments
Cardinal ligaments Correct Answer
Pubocervical ligaments
Round ligaments
Uterosacral ligaments

The cardinal ligaments attach from the lateral border of the cervix and insert into the ischial spines.
They are located at the base of the broad ligaments.
At hysterectomy they are identified and ligated with caution due to the close proximity to the ureters.

13. Which one of the following dermatomal levels innervates the knee?

L1
L2
L3 Correct Answer
L4
L5

A dermatome is an area of skin in which sensory nerves are derived from a single spinal nerve root.
There are 31 segments of the spinal cord, each with a pair of nerve roots - right and left:
The ventral nerve roots innervate motor function and dorsal nerve roots innervate sensory function.
The anterior and posterior nerve roots come together on each side to form the spinal nerves as they
exit the neuroforamina of the vertebral canal.
Dermatomes aid in the localisation of neurological levels, especially in radiculopathy.

Spinal nerve pathology may or may not lead to the development of symptoms in the dermatomal area
covered by the affected nerve roots as well as weakness or loss of deep tendon reflexes.
The L3 dermatome innervates the knee.

Reference: Medscape Reference. Dermatomes Anatomy.

14. Which one of the following dermatomal levels innervates the fifth digit of the foot?

L4
L5
 S1 Correct Answer
S2
S3
A dermatome is an area of skin in which sensory nerves are derived from a single spinal nerve root.
There are 31 segments of the spinal cord, each with a pair of nerve roots - right and left:

The ventral nerve roots innervate motor function and dorsal nerve roots innervate sensory function.
The anterior and posterior nerve roots come together on each side to form the spinal nerves as they exit the
neuroforamina of the vertebral canal.
Dermatomes aid in the localisation of neurological levels, especially in radiculopathy.

Spinal nerve pathology may or may not lead to the development of symptoms in the dermatomal area
covered by the affected nerve roots as well as weakness or loss of deep tendon reflexes.
The S1 dermatome innervates the fourth and fifth toes as well as the lateral malleolus.

Reference:Medscape Reference. Dermatomes Anatomy.

15. Which one of the following dermatomal level corresponds to the innervation of the anus?

S1
S2
S3
S4
S5 Correct Answer

Somatic innervation

•Pudendal nerve(S2-S4) via Inferior rectal nerve: sensory &motor to muscles & mucosa below dentate line

•Perineal nerve.: sensory & motor to perineal region

Autonomic innervation, Unite in inferior hypogastric plexus

•Sympathetics from thoraco-lumbar segments via sup. hypo-gastric plexus& hypogastric nn.

•Parasympathetics from S2-S4 (nervi erigentes)

•The pudendal nerve (S2-S4) supplies the skin of the anus and the external anal sphincter.

In summary: Parasympathetic fibres innervate the internal anal sphincter and sensory fibres are involved in
the reflex control of sphinters and pain.

16. Which one of the following branches of the abdominal aorta gives rise to the left gastric, splenic and
hepatic arteries?

Adrenal arteries
Coeliac trunk Correct Answer
Common iliac arteries
 Gonadal (ovarian or testicular) arteries
Inferior mesenteric artery
The coeliac trunk arises at the level of T12 and divides into the left gastric, splenic and hepatic arteries.

17. Which one of the following branches of the abdominal aorta gives rise to the intestinal, middle colic and
right colic arteries?

Inferior mesenteric artery

Lumbar arteries
Median sacral artery
Renal arteries
Superior mesenteric artery Correct Answer

The superior mesenteric artery arises at the level of L1 and divides into the

Intestinal arteries
Middle colic and
Right colic
arteries.

The superior mesenteric artery supplies the parts of the gut which are derived from the midgut.

18. Which one of the following branches of the abdominal aorta gives rise to the left colic, sigmoid and
superior rectal arteries?

Inferior mesenteric artery Correct Answer

Lumbar arteries
Median sacral artery
Renal arteries
Superior mesenteric artery
The inferior mesenteric artery arises at the level of L3 and divides into the

Left colic
Sigmoid and
Superior rectal
arteries.

This artery supplies parts of the gut which are derived from the hindgut.

19. Which one of the following branches of the abdominal aorta is an unpaired branch that arises from the
aortic bifurcation?

Inferior mesenteric artery

Lumbar arteries
Median sacral artery Correct Answer
Renal arteries
Superior mesenteric artery
The median sacral artery arises from the aortic bifurcation at the level of L4
20. Which one of the following branches of the abdominal aorta arises from the aorta between the level of L1
and L2 vertebrae, and forms five segmental arteries that do not anastomose?

Inferior mesenteric artery

Lumbar arteries
Median sacral artery
Renal arteries Correct Answer
Superior mesenteric artery
The renal arteries arise at the intervertebral disc between L1 and L2 and divide to supply the segments of the
kidneys.

21. Which one of the following nerve roots mediates the anal reflex?

C5, C6
C7, C8
C8, T1
L5, S1
S3, S4 Correct Answer

The anal reflex is elicited by pricking the perianal skin with a needle.
The normal response is an 'anal wink' and represents a visible contraction of the external anal sphincter.

22. Which one of the following nerve roots mediates the abdominal reflex?

C5, C6
C7, C8
L1 Correct Answer
L3, L4
L5, S1

The lower abdominal reflex is elicited by placing the patient in a supine position with the knees slightly bent.
Use the handle end of the reflex hammer to stroke the skin, moving lateral to medial.
The normal response is ipsilateral contraction of the rectus muscle with an observed deviation of the
umbilicus towards the stroke. When the abdominal wall is very obese, pull the skin to the opposite side, and
feel it contract towards the stimuli.

23. Which of the following nerves supply the biceps reflex?

C5, C6 Correct Answer

C7, C8
C8, T1
L1
L3, L4
The biceps jerk is elicited by supporting the patient's forearm on yours, this produces relaxation, as well as
partially flexing the patients arm. You can feel as well as see the normal response, which is contraction of
the biceps muscle and flexion of the forearm.
Other stretch reflexes include:

Triceps reflex (C6, C7, C8) anal reflexes s3 s4

Extensor digitorum reflex (C6, C7) abdominal reflexes l1
Patellar reflex (L2 - L4).
biceps reflexes C5 c6

24. Which of the following nerves supply the knee reflex?

C5, C6
C7, C8
C8, T1
L1
L3, L4 Correct Answer
The patellar reflex, or knee jerk, is elicited by letting the patient's leg dangle over the side of the bed (N.B.
the legs should not be in contact). This flexes the knee and stretches the tendon. Strike the tendon directly
just below the patella. Extension of the lower leg is the expected response. Placing the left hand on the thigh
will confirm contraction of the quadriceps.

Other stretch reflexes include:

Biceps reflex (C5, C6)
Extensor digitorum reflex (C6, C7)
Triceps reflex (C6, C7, C8).

25. Which of the following nerves supply the ankle reflex?

C7, C8
C8, T1
L1
L3, L4
L5, S1 Correct Answer
The ankle jerk is elicited by positioning the person with the knee flexed and the hip externally rotated (or
alternatively asking the patient to kneel on a chair). Hold the foot in dorsiflexion, and strike the Achilles
tendon directly. Feel the normal response as the foot plantar flexes against your hand.

Other deep tendon reflexes include:

Triceps reflex (C6, C7, C8)
Knee jerk reflex (L2, L3, L4).

26. Which of the following options describes the lymph group to which the big toe drains?

Deep inguinal lymph nodes

Internal iliac lymph nodes
Para-aortic lymph nodes
Superficial inguinal lymph nodes Correct Answer
Superior mesenteric lymph nodes
The big toe, feet, etc, drain principally to the superficial nodes.
27. Which of the following options describes the lymph group to which the vulva drains?

Deep inguinal lymph nodes

Internal iliac lymph nodes
Para-aortic lymph nodes
Superficial inguinal lymph nodes Correct Answer
Superior mesenteric lymph nodes
The vulva drains to the superficial inguinal lymph nodes.

28. Which one of the following options describes the lymph group to which the base of the cervix drains?

Deep inguinal lymph nodes

Internal iliac lymph nodes Correct Answer
Para-aortic lymph nodes
Superficial inguinal lymph nodes
Superior mesenteric lymph nodes
The cervix and rectum drain to the internal iliac nodes. + the urethra

29. Which one of the following options describes the lymph group to which the base of the cervix drains?

Deep inguinal lymph nodes

Internal iliac lymph nodes Correct Answer
Para-aortic lymph nodes
Superficial inguinal lymph nodes
Superior mesenteric lymph nodes
The cervix and rectum drain to the internal iliac nodes.

30. Which one of the following options describes the lymph group to which the distal rectum drains?

Deep inguinal lymph nodes

Internal iliac lymph nodes Correct Answer
Para-aortic lymph nodes
Superficial inguinal lymph nodes
Superior mesenteric lymph nodes
The cervix and rectum drain to the internal iliac nodes.

31. Which one of the following options describes the lymph group to which the ovaries drain?

Deep inguinal lymph nodes

Internal iliac lymph nodes
Para-aortic lymph nodes Correct Answer
Superficial inguinal lymph nodes
Superior mesenteric lymph nodes
The ovaries drain to the para-aortic lymph nodes although the vulva drains to the superficial inguinal lymph
nodes.
32. In relation to lymphatic drainage of the breasts, which one of the following options best describes the
site from where lymph drainage arises?

Infraclavicular lymph nodes

Lateral group of axillary lymph nodes
Parasternal lymph nodes
Pectoral group of axillary lymph nodes
Subareolar plexus Correct Answer
Embryologically the mammary gland is derived from the ectoderm and develops entirely within the
superficial fascia of the skin. Parenchymal lymph vessels accompany the lactiferous ducts to drain into the
dense subareolar plexus of Sappey, which is the site of lymph pooling from all parts of the breast.

The subareolar plexus has a key position in conveying lymph produced by the whole mammary gland
toward the first axillary lymph node filter.

Reference:

Borgstein PJ, Functional lymphatic anatomy for sentinel node biopsy in breast cancer: echoes from the past
and the periareolar blue method. Ann Surg. 2000 Jul;232(1):81-9.

33. In relation to lymphatic drainage of the breasts, to which of the following sites is the medial lymph most
likely to drain?

Apical group of axillary lymph nodes

Central group of axillary lymph nodes
Infraclavicular lymph nodes
Lateral group of axillary lymph nodes
Parasternal lymph nodes Correct Answer
In the lymphatic drainage of the breast, the majority of lymph - particularly from the lateral quadrants -
drains to the pectoral nodes and subsequently to the axillary nodes.

The remainder, which is mainly from the medial quadrants of the breast, drains into the parasternal lymph
nodes along the internal thoracic vessels.

Reference:Netter Anatomy. Thorax: Mammary Gland.

34. A 26-year-old female presents with right iliac fossa pain and is taken to theatre for an appendicectomy.
An incision is made through the skin and onto muscle with fibres passing inferiorly in an oblique direction.
Which abdominal wall muscle does this describe?

External oblique Correct Answer

Internal oblique
Pyramidalis
Rectus abdominis
Tranversus abdominis
The fibres of the external oblique muscle run anteriorly and inferiorly. It originates from the external
surfaces of ribs 5-12. Its insertion points are the anterior iliac crest and abdominal aponeurosis to linea alba.
The external oblique muscle is innervated by the 8th-12th intercostal nerves as well as the iliohypogastric
and ilioinguinal nerves.

35. Whilst examining the abdomen of a 21-year-old female with abdominal pain you notice a well-defined
'six-pack'.
Which abdominal wall muscle does this describe?

Cremaster
External oblique
Internal oblique
Pyramidalis
Rectus abdominis Correct Answer
The rectus abdominis are a pair of muscles which run from the bottom of the costal cartilages to the pubic
symphysis. Three tendinous insertions firmly attach the anterior rectus sheath wall to the muscle. This
muscle produces a 'six pack' appearance in athletic individuals.

The rectus abdominis origins are the pubic crest and symphysis pubis. Its insertion points are the costal
cartilages of ribs five to seven and xiphoid process of sternum. The muscles are innervated by the 7th-12th
intercostal nerves.

36. A 26-year-old female presents with right iliac fossa pain and is taken to theatre for an appendicectomy.
An incision is made through the skin and onto muscle with fibres passing superiorly in an oblique direction.
Which abdominal wall muscle does this describe?

Cremaster
External oblique
Internal oblique Correct Answer
Pyramidalis
Rectus abdominis
The origins of the internal oblique muscles are the

Anterior iliac crest

Lateral half of the inguinal ligament and
Thoraco-lumbar fascia.
Insertion points are the

Costal cartilages of ribs 8-12 and

Abdominal aponeurosis of linea alba.
The internal oblique is innervated by the

8th-12th intercostal nerves

The iliohypogstric nerve and
The ilioinguinal nerve.

37. Which of the following vessels supplies the medial and superior surfaces of the brain?
 Anterior cerebral artery Correct Answer
Anterior communicating arteries
Middle cerebral artery
Posterior cerebral artery
Posterior communicating arteries
The circle of Willis is an anastomotes of arteries located at the base of the brain.

The internal carotid artery enters the cranial cavity bilaterally and divides into the anterior cerebral artery
and middle cerebral artery. The anterior cerebral arteries are then brought together by the anterior
communicating artery. These connections form the anterior circulation of the circle of Willis.

Posteriorly, the basilar artery which is comprised of the left and right vertebral arteries, branches into a left
and right posterior cerebral artery, forming the posterior circulation. The posterior cerebral arteries join the
internal carotid vessels anteriorly via the posterior communicating arteries to complete the circle of Willis.

Reference: Medscape Reference. Circle of Willis Anatomy.

38. Which one of the following vessels supplies the inferior surface of the brain and the occipital lobe?

Anterior cerebral artery

Anterior communicating arteries
Middle cerebral artery
Posterior cerebral artery Correct Answer
Posterior communicating arteries
The circle of Willis is an anastomotes of arteries located at the base of the brain.

The internal carotid artery enters the cranial cavity bilaterally and divides into the anterior cerebral artery
and middle cerebral artery. The anterior cerebral arteries are then brought together by the anterior
communicating artery. These connections form the anterior circulation of the circle of Willis.

Posteriorly, the basilar artery which is comprised of the left and right vertebral arteries, branches into a left
and right posterior cerebral artery, forming the posterior circulation. The posterior cerebral arteries join the
internal carotid vessels anteriorly via the posterior communicating arteries to complete the circle of Willis.

Reference: Medscape Reference. Circle of Willis Anatomy

39. Which one of the following vessels supplies the lateral surface of the brain?

Anterior cerebral artery

Anterior communicating arteries
Middle cerebral artery Correct Answer
Posterior cerebral artery
Posterior communicating arteries
The circle of Willis is an anastomotes of arteries located at the base of the brain.
The internal carotid artery enters the cranial cavity bilaterally and divides into the anterior cerebral artery
and middle cerebral artery. The anterior cerebral arteries are then brought together by the anterior
communicating artery. These connections form the anterior circulation of the circle of Willis.

Posteriorly, the basilar artery which is comprised of the left and right vertebral arteries, branches into a left
and right posterior cerebral artery, forming the posterior circulation. The posterior cerebral arteries join the
internal carotid vessels anteriorly via the posterior communicating arteries to complete the circle of Willis.

Reference: Medscape Reference. Circle of Willis Anatomy.

40. Which of the following options is vessel A in the diagram of the circle of Willis?

Anterior cerebral artery Correct Answer

Basilar artery
Posterior cerebral artery
Posterior communicating artery
Vertebral artery
The circle of Willis is an anastomotes of arteries located at the base of the brain.

The internal carotid artery enters the cranial cavity bilaterally and divides into the anterior cerebral artery
and middle cerebral artery. The anterior cerebral arteries are then brought together by the anterior
communicating artery. These connections form the anterior circulation of the circle of Willis.

Posteriorly, the basilar artery which is comprised of the left and right vertebral arteries, branches into a left
and right posterior cerebral artery, forming the posterior circulation. The posterior cerebral arteries join the
internal carotid vessels anteriorly via the posterior communicating arteries to complete the circle of Willis.

Reference: Medscape Reference. Circle of Willis Anatomy.

41. Which one of the following options is vessel B in the diagram of the circle of Willis?
 Anterior cerebral artery
Basilar artery
Internal carotid artery Correct Answer
Posterior communicating artery
Vertebral artery
The circle of Willis is an anastomotes of arteries located at the base of the brain.

The internal carotid artery enters the cranial cavity bilaterally and divides into the anterior cerebral artery
and middle cerebral artery. The anterior cerebral arteries are then brought together by the anterior
communicating artery. These connections form the anterior circulation of the circle of Willis.

Posteriorly, the basilar artery which is comprised of the left and right vertebral arteries, branches into a left
and right posterior cerebral artery, forming the posterior circulation. The posterior cerebral arteries join the
internal carotid vessels anteriorly via the posterior communicating arteries to complete the circle of Willis.

Reference:Medscape Reference. Circle of Willis Anatomy.

42. Which of the following options is vessel C in the diagram of the circle of Willis?

Anterior cerebral artery

Basilar artery
Posterior cerebral artery
Posterior communicating artery Correct Answer
Vertebral artery
The circle of Willis is an anastomotes of arteries located at the base of the brain.
The internal carotid artery enters the cranial cavity bilaterally and divides into the anterior cerebral artery
and middle cerebral artery. The anterior cerebral arteries are then brought together by the anterior
communicating artery. These connections form the anterior circulation of the circle of Willis.

Posteriorly, the basilar artery which is comprised of the left and right vertebral arteries, branches into a left
and right posterior cerebral artery, forming the posterior circulation. The posterior cerebral arteries join the
internal carotid vessels anteriorly via the posterior communicating arteries to complete the circle of Willis.

Reference: Medscape Reference. Circle of Willis Anatomy.

43. Which of the following options is vessel D in the diagram of the circle of Willis?

Anterior cerebral artery

Basilar artery
Posterior cerebral artery Correct Answer
Posterior communicating artery
Vertebral artery
The circle of Willis is an anastomotes of arteries located at the base of the brain.

The internal carotid artery enters the cranial cavity bilaterally and divides into the anterior cerebral artery
and middle cerebral artery. The anterior cerebral arteries are then brought together by the anterior
communicating artery. These connections form the anterior circulation of the circle of Willis.

Posteriorly, the basilar artery which is comprised of the left and right vertebral arteries, branches into a left
and right posterior cerebral artery, forming the posterior circulation. The posterior cerebral arteries join the
internal carotid vessels anteriorly via the posterior communicating arteries to complete the circle of Willis.

Reference:Medscape Reference. Circle of Willis Anatomy.

44. Which of the following options is vessel E in the diagram of the circle of Willis?
 Anterior cerebral artery
Basilar artery Correct Answer
Posterior cerebral artery
Posterior communicating artery
Vertebral artery
The circle of Willis is an anastomotes of arteries located at the base of the brain.

The internal carotid artery enters the cranial cavity bilaterally and divides into the anterior cerebral artery
and middle cerebral artery. The anterior cerebral arteries are then brought together by the anterior
communicating artery. These connections form the anterior circulation of the circle of Willis.

Posteriorly, the basilar artery which is comprised of the left and right vertebral arteries, branches into a left
and right posterior cerebral artery, forming the posterior circulation. The posterior cerebral arteries join the
internal carotid vessels anteriorly via the posterior communicating arteries to complete the circle of Willis.

45. Which of the following options is vessel F in the diagram of the circle of Willis?
anterior cerebral artery

internal carotid artery

posterior communicating artery
posterior cerebral artery

basilar artery

vertebral artery

Anterior cerebral artery

Basilar artery
Posterior cerebral artery
Posterior communicating artery
Vertebral artery Correct Answer

The circle of Willis is an anastomotes of arteries located at the base of the brain. The internal carotid artery
enters the cranial cavity bilaterally and divides into the anterior cerebral artery and middle cerebral artery.
The anterior cerebral arteries are then brought together by the anterior communicating artery. These
connections form the anterior circulation of the circle of Willis.
Posteriorly, the basilar artery which is comprised of the left and right vertebral arteries, branches into a left
and right posterior cerebral artery, forming the posterior circulation. The posterior cerebral arteries join the
internal carotid vessels anteriorly via the posterior communicating arteries to complete the circle of Willis.

46. A 63-year-old man in the surgical ward is complaining of numbness over the anterior thigh and medial
aspect of his right leg. He is unable to extend his right knee and the knee jerk is reduced. He had undergone
a femoral aneurysm repair three days ago.
Which of the following nerves is most likely to be damaged in this scenario?

Femoral branch of the genitofemoral nerve

Femoral nerve Correct Answer
Lateral cutaneous nerve of thigh
Lateral plantar nerve
Sciatic nerve
The femoral nerve (L2-4) may be injured by:

Surgeries to the femoral triangle, such as femoral embolectomy, femoro-popliteal bypass or femoral
aneurysm repair
Massive haematoma within the thigh
Traction during surgery
Any form of trauma, including gunshot wounds to the femoral triangle.
Injury to the femoral nerve causes weakness of the quadriceps muscle causing a weak knee extension. The
knee may give way on walking and the patient has difficulty climbing stairs.

There is numbness over the anterior thigh and medial aspect of the leg. The knee jerk is reduced or absent.

47. A 33-year-old lady, who is 38 weeks pregnant, presents to her general practitioner with a four week
history of pain and paraesthesia over the upper outer aspect of her right thigh. There is no restriction of
movements in her hips or knees and her gait is normal.
Which of the following nerves is most likely to be damaged in this scenario?

Femoral branch of the genitofemoral nerve

Femoral nerve
Lateral cutaneous nerve of thigh Correct Answer
Lateral plantar nerve
Sciatic nerve
The lateral cutaneous nerve of the thigh may be compressed in pregnancy or with any condition which
causes pressure on this nerve, such as injuries in the region of the anterior superior iliac spine or the
inguinal ligament.
Also known as meralgia paraesthetica, it is a form of entrapment neuropathy.
Patients with this disorder present with pain, paraesthesia and sensory loss over the upper, lateral aspect of
the thigh.
No treatment is necessary as the condition is often self-limiting.

48. A 71-year-old woman presents to the orthopaedic outpatient clinic with left-sided foot drop and altered
sensation below the lateral side of the knee. There is loss of knee flexion and absent ankle jerk.
She had undergone left total hip replacement six weeks ago.
Which of the following nerves is most likely to be damaged in this scenario?
 Femoral branch of the genitofemoral nerve
Femoral nerve
Lateral cutaneous nerve of thigh
Lateral plantar nerve
Sciatic nerve Correct Answer
The sciatic nerve (L4-S3) may be injured in the following cirucmstances:

Following surgery, such as total hip replacement

Dislocation of the hip
Trauma, such as high speed road traffic accidents causing posterior dislocation of the hip
Other traction injuries to the nerve
Complete lesion of the sciatic nerve will affect all the muscles below the knee leading to loss of knee flexion,
foot drop and an inability to walk.

The patient is unable to stand for prolonged periods and is often found to drag his or her feet behind. There
is loss of sensation below the knee on the lateral side (saphenous nerve supplies the medial side).

The knee jerk is normal (supplied by the femoral nerve) but the ankle jerk is lost. There may be calf muscle
wasting in the long term.

49. To which group of lymph nodes does lymph from the testis first pass?

Deep inguinal
Inferior mesenteric
Internal iliac
Para-aortic Correct Answer
Superficial inguinal
Lymphatic drainage from the testis initially passes to the para-aortic lymph nodes.

Patients who have non-seminomatous testicular cancer have a higher risk of cancer spread to para-aortic or
retroperitoneal lymph nodes.1

Reference:The Cancer MD. Testicular Cancer & Gary's Story - Part II.

50. To which group of lymph nodes does lymph from the rectum first pass?

Deep inguinal
Inferior mesenteric
Internal iliac Correct Answer
Para-aortic
Superficial inguinal
Lymphatic drainage from the rectum initially passes to the internal iliac lymph nodes.

Inguinal metastases are more common in malignancies localised to the lower third of the rectum.

Reference: McMahon CJ, Rofsky NM, Pedrosa I. Lymphatic metastases from pelvic tumors: anatomic
classification, characterization, and staging. Radiology. 2010;254(1):31-46.
51. To which group of lymph nodes does lymph from the vulva first pass?

Deep inguinal
Inferior mesenteric
Internal iliac
Para-aortic
Superficial inguinal Correct Answer
Lymph from the vulva and penis drains to the superficial inguinal nodes.

Reference: Netter Anatomy. Pelvis and Perineum: Vasculature.

52. To which group of lymph nodes does lymph from the scrotum first pass?

Deep inguinal
Inferior mesenteric
Internal iliac
Para-aortic
Superficial inguinal Correct Answer
Lymph from the scrotum and penis drains to the superficial inguinal lymph nodes.

53. To which group of lymph nodes does lymph from the hallux first pass?

Deep inguinal
Inferior mesenteric
Internal iliac
Para-aortic
Superficial inguinal Correct Answer
The superficial subgroup lies anterior to the inguinal ligament, the superficial femoral vessels and the
saphenous veins.
The inguinal lymph nodes filter lymphatic fluid that drains the genitals, groin, legs and feet.
Lymph from the hallux initially passes to the superficial inguinal lymph nodes.

54. To which group of lymph nodes does lymph from the cervix first pass?

Deep inguinal
Inferior mesenteric
Internal iliac Correct Answer
Para-aortic
Superficial inguinal
The lymphatics of the cervix follow the uterine vein, draining into the internal iliac lymph nodes.

Reference: LWW Oncology. Uterine Cervix.

55. To which group of lymph nodes does lymph from the upper anal canal first pass?
 Deep inguinal
Inferior mesenteric
Internal iliac Correct Answer
Para-aortic
Superficial inguinal
Lymphatic vessels from the inferior half of the rectum follow the middle rectal vessels to the internal iliac
nodes and anastomose with the lymphatics of the anal canal.1

Reference: Netter Anatomy. Pelvis and Perineum: Rectum

56. Which muscle of the lower limb is primarily responsible for hip flexion?

Extensor hallucis longus

Iliopsoas Correct Answer
Peroneus longus
Quadriceps
Tibialis anterior
The iliopsoas consists of two closely related muscles, the iliacus and psoas major. The iliacus arises from
the iliac fossa on the interior side of the hip bone, and also from the region of the anterior inferior iliac spine
(AIIS).

The psoas major is divided into a superficial and deep part. The deep part originates from the transverse
processes of lumbar vertebrae I-V. The superficial part originates from the lateral surfaces of the last
thoracic vertebra, lumbar vertebrae I-IV, and from neighbouring invertebral discs.

The iliopsoas contributes to flexion and external rotation in the hip joint and is important for standing,
walking, and running. It is the strongest of the hip flexors (others are rectus femoris, sartorius, and tensor
fasciae latae).

57. Which muscle of the lower limb is primarily responsible for knee extension?

Extensor hallucis longus

Iliopsoas
Peroneus longus
Quadriceps Correct Answer
Tibialis anterior
The quadriceps muscle is mainly responsible for knee extension.

The quadriceps femoris insertion into the patella is through a common tendon with a three-layered
arrangement: most superficially rectus femoris, vastus medialis and lateralis in the intermediate layer and in
the deepest layer vastus intermedius.1

Reference: Waligora AC, Johanson NA, Hirsch BE. Clinical anatomy of the quadriceps femoris and extensor
apparatus of the knee. Clin Orthop Relat Res. 2009;467(12):3297-306.

58. Which muscle of the lower limb is primarily responsible for ankle dorsiflexion?
 Extensor hallucis longus
Iliopsoas
Peroneus longus
Quadriceps
Tibialis anterior Correct Answer
The tibialis anterior muscle is located most medially in the anterior compartment of the leg.

It is responsible for dorsiflexion and inversion of the foot. The tibialis muscle also functions to stabilise the
ankle as the foot hits the ground during the contact phase of walking and later pulls the foot off the ground
during the swing phase.

Reference: Uzun B, et al. Dynamic measurements of musculus tibialis anterior ligaments with different
angles. Journal of Biomechanics. 2011;44 Supp 1:2.

59. Which muscle of the lower limb is primarily responsible for extension of the distal phalanx of the great
toe?

Extensor hallucis longus Correct Answer

Iliopsoas
Peroneus longus
Quadriceps
Tibialis anterior
The extensor hallucis longus dorsiflexes the hallux and inverts the foot.

The extensor hallucis longus is the muscle mainly responsible for extension of the distal phalanx of the
great toe.

Referene: Netter Anatomy. Lower Limb: Leg.

60. Which muscle of the lower limb is primarily responsible for eversion of the foot?

Extensor hallucis longus

Iliopsoas
Peroneus longus Correct Answer
Quadriceps
Tibialis anterior
The peroneus longus muscle is one of the muscles primarily involved in eversion of the foot.

Reference: Netter Anatomy. Lower Limb: Leg.

61. Which of the following dermatomes supplies the middle finger?

C7 Correct Answer
L5
S1
T4
T10
A dermatome is an area of skin in which sensory nerves are derived from a single spinal nerve root.
There are 31 segments of the spinal cord, each with a pair of nerve roots - right and left:

The ventral nerve roots innervate motor function and dorsal nerve roots innervate sensory function.
The anterior and posterior nerve roots come together on each side to form the spinal nerves as they exit the
neuroforamina of the vertebral canal.
Dermatomes aid in the localisation of neurological levels, especially in radiculopathy. Spinal nerve
pathology may or may not lead to the development of symptoms in the dermatomal area covered by the
affected nerve roots as well as weakness or loss of deep tendon reflexes.

The C7 dermatome innervates the middle finger.

Reference: Medscape Reference. Dermatomes Anatomy.

62. Which of the following dermatomes supplies the nipple?

C7
L5
S1
T4 Correct Answer
T10
A dermatome is an area of skin in which sensory nerves are derived from a single spinal nerve root.

There are 31 segments of the spinal cord, each with a pair of nerve roots - right and left:

The ventral nerve roots innervate motor function and dorsal nerve roots innervate sensory function.
The anterior and posterior nerve roots come together on each side to form the spinal nerves as they exit the
neuroforamina of the vertebral canal.
Dermatomes aid in the localisation of neurological levels, especially in radiculopathy. Spinal nerve
pathology may or may not lead to the development of symptoms in the dermatomal area covered by the
affected nerve roots as well as weakness or loss of deep tendon reflexes.

The T4 dermatome innervates the nipple.

Reference: Medscape Reference. Dermatomes Anatomy.

63. Which of the following dermatomes supplies the umbilicus?

C7
L5
S1
T4
T10 Correct Answer
A dermatome is an area of skin in which sensory nerves are derived from a single spinal nerve root.

There are 31 segments of the spinal cord, each with a pair of nerve roots - right and left:

The ventral nerve roots innervate motor function and dorsal nerve roots innervate sensory function.
The anterior and posterior nerve roots come together on each side to form the spinal nerves as they exit the
neuroforamina of the vertebral canal.
Dermatomes aid in the localisation of neurological levels, especially in radiculopathy. Spinal nerve
pathology may or may not lead to the development of symptoms in the dermatomal area covered by the
affected nerve roots as well as weakness or loss of deep tendon reflexes.

The T10 dermatome innervates the umbilicus.

Reference: Medscape Reference. Dermatomes Anatomy.

64. Which of the following dermatomes supplies the big toe?

C7
L5 Correct Answer
S1
T4
T10
A dermatome is an area of skin in which sensory nerves are derived from a single spinal nerve root.

There are 31 segments of the spinal cord, each with a pair of nerve roots - right and left:

The ventral nerve roots innervate motor function and dorsal nerve roots innervate sensory function.
The anterior and posterior nerve roots come together on each side to form the spinal nerves as they exit the
neuroforamina of the vertebral canal.
Dermatomes aid in the localisation of neurological levels, especially in radiculopathy. Spinal nerve
pathology may or may not lead to the development of symptoms in the dermatomal area covered by the
affected nerve roots as well as weakness or loss of deep tendon reflexes.

The L5 dermatome innervates the first to third toes.

Reference: Medscape Reference. Dermatomes Anatomy.

65. Which of the following dermatomes supplies the lateral aspect of the foot?

C7
L5
S1 Correct Answer
T4
T10
The S1 dermatome supplies the

Heel
Lateral aspect of the foot
Lateral aspect of the posterior thigh
and most of the

Posterior lower leg.

66. Which of the following nerves supplies the triceps muscle?

Axillary nerve
Median nerve
Radial nerve Correct Answer
Tibial nerve
Ulnar nerve
The radial nerve is the main innervation of all the extensors of the upper limb.

It also supplies

Brachioradialis
Supinator
Abductor pollicis longus
and has a sensory cutaneous branch.

67. Which of the following nerves supplies the opponens pollicis muscle?

Axillary nerve
Median nerve Correct Answer
Radial nerve
Tibial nerve
Ulnar nerve
The median nerve innervates the flexors of the digits of the hand, flexor carpi radialis, pronator teres and to
five muscles of the hand (commonly remembered by the acronym LOAF):

First Lumbrical
Second lumbrical
Opponens pollicis
Abductor pollicis brevis
Flexor pollicis brevis.
The median nerve also gives sensory innervation.

68. Which of the following nerves supplies the gastrocnemius muscle?

Axillary nerve
Median nerve
Radial nerve
Tibial nerve Correct Answer
Ulnar nerve

The tibial nerve is a continuing branch of the sciatic nerve which supplies
Gastrocnemius
Soleus
Tibialis posterior
and the longer flexors of the digits of the feet.
69. Which of the following nerves supplies the abductor digiti minimi muscle?

Axillary nerve
Median nerve
Radial nerve
Tibial nerve
Ulnar nerve Correct Answer
The ulnar nerve supplies flexor carpi ulnaris and most of the small intrinsic muscles of the hand.

70. Which of the following nerves supplies the deltoid muscle?

Axillary nerve Correct Answer

Median nerve
Radial nerve
Tibial nerve
Ulnar nerve
The axillary nerve supplies the deltoid and also teres minor.

It also gives off a cutaneous branch.

71. Which of the following hormones is secreted by decidual cells of the placenta?

Human chorionic gonadotrophin

Human placental lactogen
Leptin
Oestrogen
Relaxin Correct Answer
The decidua of the placenta, that is, maternal-fetal interface produces intrauterine relaxin.

The choriodecidua expresses LGR7 which is its receptor.1 It is thought that relaxin leads to remodelling of
the reproductive tract connective tissue, inducing biochemical changes in the cervix.2

Relaxin is secreted by the decidual cells of the placenta.

References:
Horton JS, et al. Identification of relaxin-responsive cells in the human choriodecidua at term. Ann N Y Acad
Sci. 2009;1160:136-7.
Medscape Reference. Common Pregnancy Complaints and Questions.

72. Which of the following structures is the origin of the uterus?

Genital tubercle
Mesonephric duct
Metanephric blastema
Paramesonephric duct Correct Answer
Urethral folds
The paramesonephric ducts - also known as müllerian ducts - differentiate to form the fallopian tubes,
uterus, uterine cervix and superior aspect of the vagina. A wide variety of malformations can occur when
this system is disrupted.1 Women with a uterine anomaly are at risk of preterm birth.

This highlights an at-risk population in need of additional study for possible interventions in order to
prevent preterm birth.

The paramesonephric ducts give rise to the uterus.

Reference: Medscape Reference. Mullerian Duct Anomalies.

73. Which one of the following structures is the origin of the labia minora?

Genital tubercle
Mesonephric duct
Metanephric blastema
Paramesonephric duct
Urethral folds Correct Answer
In the developing embryo the external genitalia are comprised of a small genital tubercle, urethral folds and
genital (labioscrotal) swellings.

In the female, the genital tubercle becomes the clitoris, the urethral folds develop into the labia minora and
the labioscrotal swelling forms the labia majora.

Reference: Atlas of Human Embryology. External genitalia.

74. Which artery provides the main blood supply of the breast?

Axillary artery
Internal mammary artery Correct Answer
Lateral thoracic artery
Superior thoracic artery
Thoracoacromial artery
The blood supply of the breast is derived mainly from the internal mammary artery.

Approximately one-third of the blood supply of the breast - mainly to the upper outer quadrant - is provided
by the lateral thoracic arteries.

75. Which of the following is true of the position of the heart in pregnancy?

No change in position
Shift to the left and anteriorly Correct Answer
Shift to the left and posteriorly
Shift to the right and anteriorly
Shift to the right and posteriorly
As the uterus enlarges in pregnancy the mother's heart is shifted to the left, anteriorly and rotated towards a
transverse position resulting the apical impulse becoming shifted to the fourth intercostal space.
76. Which of the following statements regarding the jejunum is true?

The mesentery of the jejunum attaches it to the anterior abdominal wall

The jejunum is less vascular than the ileum
The small bowel constitutes 3/5 of the jejunum and ileum combined Correct Answer
The jejunum is thinner than the ileum
The jejunal blood supply is from the coeliac axis
The jejunum comprises 2/5 of the small bowel (excluding the duodenum).

It is thicker and more vascular than the ileum and this is[Link]
corp/Polycystic%20Ovary%20Syndrome%20(PCOS).pdf palpable during surgery which helps differentiate
the two.

The whole of the jejunum and the ileum is enclosed in peritoneum leaving it a long border that is double
layered and forms the mesentery.

The mesentery attaches the intestine to the posterior abdominal wall and the blood supply, nerve and
lymphatics run through it.

The blood supply is from the the jejunal branch of the superior mesenteric artery.

77. Which of the following statements regarding Meckel's diverticulum is true?

Gastric mucosa can be found in the diverticulum Correct Answer

Is present in approximately 10% of patients
Is usually about 10cm long
Occurs at the ileocaecal valve
The remains of the vitello-intestinal duct may run from tip of diverticulum to posterior abdominal
wall

A Meckel's diverticulum is present in approximately 2% of patients typically 20-40 cm from the ileocaecal
valve.

It is typically a blind-ended pouch around 5 cm long.

A thin fibrous band is occasionally found running from the tip of the diverticulum to the umbilicus which
constitutes the remains of the vitello-intestinal duct.

Gastric mucosa and, rarely, pancreatic tissue may be found in the diverticulum and form the source of
pathology associated with this anatomical variation.

78. Which of the following statements regarding the large bowel is true?

The caecum can be attached to the fascia of the underlying iliacus and psoas
The large bowel contains appendices epiploicae Correct Answer
 The large bowel is more mobile than the small bowel
The left colic flexure is lower than the right colic flexure
The transverse colon runs to the left of the abdomen with a slight downwards angulation

The large intestine begins in the right iliac fossa at the caecum, runs up to inferior surface of the liver before
turning sharply at the right colic flexure and becoming the transverse colon.

The transverse colon then runs slightly upwards and to the left turning sharply again as the left colic flexure
at a higher level than the right colic flexure.

The large bowel is less mobile than the small bowel and is differentiated from such by its taeniae coli
(longitudinal condensed bands) and appendices epiploicae (fatty subserosal projections).

Occasionally the caecum can be found attached to the fascia of psoas or iliacus beneath it, securing the
caecum from twisting, which can produce a volvulus after delivery.