MCEM Anatomy MCQ PDF

MCEM MCQ Anatomy
1. Mandible Injuries
(a) The angle of the mandible is the most common area to be fractured.
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In which the talus is driven into the calcaneus. Or a twisting injury.

(c) Over 20% of calcaneal fracture patients suffer associated injuries of the spine,
pelvis or hip.
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(d) Internuclear opthalmoplegia occurs when there is failure of adduction of one

eye and nystagmus in the opposite eye.
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(e) Quadriceps tendon rupture is most common is individuals under 40 years of

age
Quadriceps tendon rupture is most common is individuals over 40 years of age
after sudden contraction of the quadriceps muscle.
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23% of the time.

(b) Marfans syndrome increases the likelihood of mandibular dislocation
Marfans syndrome increases the likelihood of mandibular dislocation as does
Ehlers Danlos syndrome.
(c) Most dislocations ( >70% ) are traumatic
Most dislocations occur spontaneously when the jaw is open wide.
(d) With dislocation patients are unable to close their mouths completely and have
difficulty speaking.
With dislocation patients are unable to close their mouths completely and have
difficulty speaking.
(e) Plain radiographs are usually unhelpful in dislocation of the mandible.
Plain radiographs of the mandible, including bilateral oblique views, virtually
always show the affected condyle lying anterior to the articular eminence
2. The following are true:
(a) Calcaneal fracture is the most commonly fractured tarsal bone.
Calcaneus injuries represent 2% of all fractures seen in adults. The os calcis is the
most frequently fractured tarsal bone, accounting for more than 60% of tarsal
fractures. Calcaneus fractures are most commonly seen in young men' Scott
Nicklebur, MD, Calcaneus Fractures; www.emedicine.com
(b) The mechanism of injury of calcaneal fracture is axial loading.
3. The Subclavian Artery:

(a) On the left the Subclavian artery arises directly from the aorta but on the right
it is a branch of the brachiocephalic trunk
On the left the Subclavian artery arises directly from the aorta but on the right it is
a branch of the brachiocephalic trunk
(b) Behind and above the subclavian artery are the roots of the brachial plexus.
Behind and above the subclavian artery are the roots of the brachial plexus.
(c) At the outer border of the third rib the subclavian artery changes it?s name to
the axillary artery.
At the outer border of the first rib the subclavian artery changes its name to the
axillary artery.
(d) The internal thoracic artery is a branch of the subclavian artery.
The internal thoracic artery is a branch of the subclavian artery.
(e) The scalenus anterior separates the subcalvian vein in front from the
subclavian artery behind.
The scalenus anterior separates the subcalvian vein in front from the subclavian
artery behind
MCEM MCQ Anatomy

4. Chest drain insertion:
(a) Normal position is between the 4th and 5th IC spaces.
The normal position is between the 4th and 5th IC spaces.
(b) Between the anterior and mid-axillary line
Between the anterior and mid-axillary line.
(c) The point at which the anterior axillary fold meets the chest wall is a useful
guide.
The point at which the anterior axillary fold meets the chest wall is a useful guide.
(d) If the chest drain initially yields 1000ml of blood, or subsequently drains
>200ml/hr there should be urgent referral to a cardiothoracic surgeon.
If the chest drain initially yields 1000ml of blood, or subsequently drains
>200ml/hr there should be urgent referral to a cardiothoracic surgeon for possible
thoracotomy.
(e) Lateral chest wall to the apices is a reflection of tube length for drainage of a
pneumothorax.
Lateral chest wall to the apices is a reflection of tube length for drainage of a
pneumothorax.
5. Regional Anaeasthesia
(a) The radial nerve provides sensation to the lateral two thirds of the dorsum of
the hand
The radial nerve provides sensation to the lateral two thirds of the dorsum of the
hand
(b) 1% lignocaine has a concentration of 1mg/ml
1% lignocaine has a concentration of 10mg/ml
(c) The median nerve is anaesthetised by injecting local between the flexor carpi
radialis and the palmaris longus.
The median nerve is anaesthetised by injecting local between the flexor carpi
radialis and the palmaris longus.
(d) The median provides sensation to the lateral two thirds of the palm of the
hand, palmar surfaces of the lateral three and one half digits, and their fingertips
Provides sensation to the lateral two thirds of the palm of the hand, palmar
surfaces of the lateral three and one half digits, and their fingertips
(e) At the wrist the ulnar nerve is blocked by injecting local anaesthetic between
the ulnar artery and the flexor carpi ulnaris.
At the wrist the ulnar nerve is blocked by injecting local anaesthetic between the
ulnar artery and the flexor carpi ulnaris.
6. Ruptured Achilles ( calcaneal ) tendon
(a) Pain has a gradual onset while running or jumping.
Pain has a sudden onset while running or jumping.
(b) The rupture usually occurs about 1 cm above the tendon insertion.
The rupture usually occurs about 5 cm above the tendon insertion.
(c) Pain may be perceived as a kick.
(d) It is impossible to walk after an achilles tendon rupture.
It is still possible to walk after an achilles tendon rupture, though with a limp.
(e) It is impossible to plantar flex the foot after an achilles tendon rupture.
A degree of plantar flexion is still possible.It is impossible to raise the heel from
the floor when the foot is on the ground.
A gap may be felt in the tendon course (particularly within 24 hours of the injury).
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MCEM MCQ Anatomy

On examination the patient cannot stand on tip-toe.
7. Primary motor and sensory cortices
(a) Motor=precentral gyrus
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(d) Somatosensory=postcentral gyrus
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(e) Visual= Calcarine sulcus
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Frontal lobe
(b) Auditory=Superior temporal lobe
Heschl's gyrus
(c) Olfactory=fontal lobe
In the occipital cortex

8. The Brachial Plexus:
(a) Behind the clavicle each trunk divides into the anterior and posterior cords.
Behind the clavicle each trunk divides into the anterior and posterior division
(b) The posterior divisions of the upper and middle trunk make up the lateral cord.
The anterior divisions of the upper and middle trunk make up the lateral cord.
(c) The roots of the brachial plexus emerge into the posterior triangle in front of
the scalenus anterior and the scalenus medius.
The roots of the brachial plexus emerge into the posterior triangle between the
scalenus anterior and the scalenus medius.
(d) The root of the ventral ramus of T1 makes the middle trunk of the brachial
plexus
The root of the ventral ramus of C7 makes the middle trunk of the brachial plexus
(e) The brachial plexus is sequentially divided into the roots, the trunks , the
divisions, and the cords.
The brachial plexus is sequentially divided into the roots, the trunks , the divisions,
and the cords.
9. The following are true regarding the vertebral column:
(a) There are seven cervical vertebrae
There are seven cervical vertebrae.
(b) There are 12 thoracic vertebrae.
There are 12 thoracic vertebrae.
(c) There are five lumbar vertebrae
There are five lumbar vertebrae.
(d) There are three sacral vertebrae.
There are five sacral vertebrae fused to form the sacrum
(e) There are three coccygeal vertebrae.
There are four coccygeal vertebrae which are usually fused.
10. Neck Trauma
(a) Penetrating neck trauma rarely causes multiple injuries.
Multiple injuries are sustained 44 to 52% of the time with penetrating neck
trauma.
(b) Strangulation may cause the formation of petechiae in the subconjunctivae.
MCEM MCQ Anatomy
(c) Strangulation may cause the formation of petechiae below the level of injury.
Strangulation may cause the formation of petechiae above the level of injury.
(d) Major vessel injury may simulate an acute stroke.
(e) Vascular injury is most common with blunt trauma.
Vascular injury is most common with penetrating trauma.
11. The 2nd Cranial Nerve:
(a) Normal visual acuity is present when the line on the snellen chart marked 6
can be read from 6 metres away.
Normal visual acuity is present when the line on the snellen chart marked 6 can be
read from 6 metres away.
(b) Migraine is a cause of sudden blindness in both eyes
Migraine is a cause of sudden blindness in one eye.
(c) The fibres from the optic chiasm concerned with vision travel in the optic tract
to the medial geniculate body.
The fibres from the optic chiasm concerned with vision travel in the optic tract to
the lateral geniculate body.
(d) Fibres from the optic radiation pass through the anterior part of the internal
capsule and finish in the visual cortex in the occipital lobe.
Fibres from the optic radiation pass through the posterior part of the internal
capsule and finish in the visual cortex in the occipital lobe.
(e) Fibres serving the lower quadrants course through the parietal lobe while fibres
serving the upper quadrants traverse the temporal lobe.
Fibres serving the lower quadrants course through the parietal lobe while fibres
serving the upper quadrants traverse the temporal lobe.
12. Joints
(a) Patellofemoral dislocation is the commonest large joint dislocation.
Glenohumeral dislocation is the commonest large joint dislocation.
(b) Glenohumeral dislocation is the second commonest large joint dislocation
Patellofemoral dislocation is the second commonest large joint dislocation.
(c) Elbow dislocations are the third largest large joint dislocation in the body.
Elbow dislocations are the third largest large joint dislocation in the body.
(d) The majority of elbow dislocations are posterior.
The majority of elbow dislocations are posterior.
(e) The most common mechanism of injury during elbow dislocation is direct
trauma to the olecranon when a person falls on a flexed elbow.
The most common mechanism of injury for an elbow dislocation is fall on an
outstretched hand ( FOOSH )
13. Aortic Dissection
(a) The vast majority of patients have physical signs suggestive of dissection.
The presence of pulse deficits or focal neurological deficits increases the likelihood
of an acute thoracic aortic dissection in the appropriate clinical setting.
Conversely, a completely normal chest radiograph result or the absence of pain of
sudden onset lowers the likelihood. Overall, however, the clinical examination is
insufficiently sensitive to rule out aortic dissection given the high morbidity of
missed diagnosis.Klompass M. Does this patient have an acute thoracic
dissection? JAMA 2002; 287: 2262?72.
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MCEM MCQ Anatomy

(b) Sudden onset chest pain is present in 99% of cases
Sudden onset chest pain is present in about 85% of cases.Klompass M. Does this
patient have an acute thoracic dissection? JAMA 2002; 287: 2262?72.
(c) D-Dimers are usually not raised on acute thoracic dissection
D-Dimer assay is usually raised in acute thoracic dissection
(d) Most chest X Ray's do not show an abnormality
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Most chest X Ray's do show abnormalities. Among the most common

abnormalities are widened mediastinum and an abnormal contour of the aorta.
14. Ovarian Cysts
(a) Are present in about 6% of asymptomatic post menopausal women
(b) May present with urinary retention
Though normally symptomless
(c) Can be most accurately diagnosed by trans abdominal ultrasound as malignant
Vaginal ultrasound is much more accurate predicting benign nature in up to 96%
of cases
(d) After the menopause are best managed by a wait and see policy
This is reasonable in pre menopausal women
(e) Standard surgical treatment is to remove all cysts over 5cm in diameter
Because there is a 15% risk of malignancy
15. The following are true of the sensory supply to the hand
(a) The radial nerve supplies sensation to the dorsal surface of the hand in the
region of the little finger.
The radial nerve supplies sensation to the dorsal surface of the hand in the region
of the thumb.The radial nerve is composed of fibers from C6, C7 and C8
(b) The median nerve is the only sensory supply to the anterior surface of the ring
finger.
The sensory supply of the medial half of the anterior surface of the ring finger is
from the ulnar nerve. The sensory supply of the lateral half of the anterior surface
of the ring finger is from the medial nerve.
(c) The ulnar nerve supplies part sensation to the posterior surface of the ring
finger.
The ulnar nerve supplies part sensation to the posterior surface of the ring finger.
(d) Sensation to the dorsal tip of the index finger is supplied by the radial nerve.
Sensation to the dorsal tip of the index finger is supplied by the median nerve.
(e) The radial nerve has no anterior hand sensory fibres.
On the anterior surface the median nerve supplies the lateral 3 1/2 digits while the
ulnar nerve supplies the medial 1 1/2 digits. The radial nerve supplies sensory
fibres to the anterior surface of the thumb. On the dorsal surface the radial nerve
supplies most of the dorso-lateral hand but not distal to the PIP joints of the
index,middle and ring fingers which are supplied by the median nerve. The medial
1 1/2 digits are supplied by the ulnar nerve on the dorsal surface.
16. Regional Anaesthesia
(a) The total volume of the anaesthetic agent should not exceed 8 mL for a digital
nerve block.
The total volume of the anaesthetic agent should not exceed 4 mL for a digital
nerve block.
(b) The sural nerve is blocked between the lateral malleolus and the Achilles
MCEM MCQ Anatomy

tendon.
The sural nerve is blocked between the lateral malleolus and the Achilles tendon
(c) The sural nerve lies just anterior to the short saphenous vein.
The sural nerve lies just anterior to the short saphenous vein.
(d) The saphenous nerve is blocked between the lateral malleolus and the anterior
tibial tendon.
The saphenous nerve is blocked between the medial malleolus and the anterior
tibial tendon.
(e) The posterior tibial nerve is blocked by injecting the local anaesthetic between
the posterior tibial artery and lateral malleolus.
The posterior tibial nerve is blocked by injecting the local anaesthetic between the
posterior tibial artery and achilles tendon at the level of the medial malleolus.
17. Finger injuries:
(a) The mallet finger deformity is produced by avulsion of the flexor tendon from
its insertion.
Extensor tendon!
(b) If a fracture of the distal phalanx effects more than 1/3 rd of the the joints
articular surface the joint may become unstable.
If a fracture of the distal phalanx effects more than 1/3 rd of the the joints articular
surface the joint may become unstable.
(c) Hyperextension of the finger at the base of the metacarpophalangeal joint may
result in a transverse fracture at the base of the proximal phalanx.
Hyperextension of the finger at the base of the metacarpophalangeal joint may
result in a transverse fracture at the base of the proximal phalanx.
(d) Fracture of the metacarpal neck with volar displacement of the head is
commonest in the 4th metacarpal.
Commonest in the 5th metacarpal, a boxers fracture.
(e) A Salter-Harris type II epiphyseal fracture of the base of the little finger
proximal phalanx is commonly from an abduction injury.
A Salter-Harris type II epiphyseal fracture of the base of the little finger proximal
phalanx is commonly from an abduction injury.
18. Hand Injuries
(a) A boxers fracture is the most common metacarpal fracture
Fracture of the 4th or 5th metacarpal neck
(b) Crush injuries to the hand are not at risk of compartment syndrome
Crush injuries to the hand are at risk of compartment syndrome.
(c) Treatment of non-displaced middle phalanx fractures includes a gutter splint in
the position of function and referral
Treatment of non-displaced middle phalanx fractures includes a gutter splint in
(d) Treatment of non-displaced proximal phalanx fractures includes a gutter splint
in the position of function and referral
Treatment of non-displaced proximal phalanx fractures includes a gutter splint in
(e) If more than one third of the articular surface of the distal phalanx is involved
in a fracture internal fixation is recommended
If more than one third of the articular surface of the distal phalanx is involved in a
fracture internal fixation is recommended
19. Trapezium Fracture
(a) Results in painful ring finger movements
Trapezium fracture results in painful thumb movements.
(b) Tenderness is present at the base of the hypothenar eminence
Tenderness is present at the base of the thenar eminence
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MCEM MCQ Anatomy

(c) Treatment consists of an above elbow backslab and orthopaedic referral.
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(c) The second of cambells lines runs along the inferior orbital margins
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(d) A teardrop sign is associated with an orbital margin fracture
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(b) Breath sounds should be checked for at the anterior chest wall bilaterally.
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(c) Breath sounds are normally louder on the right side of the chest wall.
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Treatment consists of a thumb spica splint and orthopaedic referral.

(d) Patients usually complain of a painful and weak pinch.
(e) Trapezial fractures usually result from a direct blow to the dorsum of the hand
or from a fall on a radially deviated closed fist
Trapezial fractures usually result from a direct blow to the dorsum of the hand or
from a fall on a radially deviated closed fist. Patients usually complain of a painful
and weak pinch. On clinical examination, point tenderness is present on direct
palpation of the trapezium.
20. Testis, epididymis and spermatic cord:
(a) A hydrocele occurs when there is watery fluid between the parietal and visceral
layers of the tunica vaginalis ( a serous sac of peritoneal origin )
A hydrocele occurs when there is watery fluid between the parietal and visceral
(b) The testicular artery is a direct branch of the abdominal aorta which arises just
above the renal arteries and descends in the spermatic cord to the posterior
aspect of the testes.
The testicular artery is a direct branch of the abdominal aorta which arises just
below the renal arteries and descends in the spermatic cord to the posterior
(c) The ductus deferens ascends on the lateral side of the epididymis.
The ductus deferens ascends on the medial side of the epididymis.
(d) The epididymis is on the posterior aspect of the testes and is 3 m in length.
The epididymis is on the posterior aspect of the testes and is 6 m in length.
(e) The head of the epididymis lies on the upper pole of the testis where it is joined
by the efferent ducts.
The head of the epididymis lies on the upper pole of the testis where it is joined by
the efferent ducts.
21. Maxillofacial Radiographs
(a) Should be assessed by tracing cambells lines
There are 5 of them.The first runs from the zygomaticofrontal suture above the
orbital margins and across the glabella.
(b) The first of cambells lines runs from the zygomaticofrontal suture above the
orbital margins and across the glabella.
A feature of a downward blow out fracture

(e) Soft tissue swelling is a direct sign of maxillary fracture
Soft tissue swelling is an indirect sign, as are opacification of the maxillary sinus.
22. Proper tracheal tube placement: Auscultation
(a) Breath sounds should be checked for at the lateral chest wall bilaterally.
MCEM MCQ Anatomy

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(b) raising intra abdominal pressure to assist in micturition
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(c) helps in weight lifting
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(d) Assists in return of blood to the right side of the heart
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(e) Assists in initiation of movement
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(d) Gastric bubbling noises are heard over the epigastrium.

This may indicate the tube is not in the trachea.
(e) Chest expansion is often greater on the right hand side.
Chest expansion should be equal.
23. The phrenic nerve is involved in
(a) pulling the diaphragm down on inspiration
The diaphragm moves down on inspiration to increase the vertical diameter of the
thorax. Increasing intra abdominal pressure will aid in micturition, parturition and
defecation. By taking a deep breath and holding it you can fix the diaphragm to
raise intra abdominal pressure to such an extent that it prevents vertebral column
flexion. By raising intraabdominal pressure and lowering intrathoracic pressure the
venous return to the right side of the heart is encouraged.
24. The Femoral Triangle:
(a) The femoral vein is medial to the femoral nerve.
The femoral vein is medial to the femoral nerve.
(b) The femoral canal is on the lateral side of the femoral artery in the femoral
triangle.
The femoral canal is on the medial side of the femoral artery in the femoral
triangle.
(c) The femoral artery is a continuation of the external iliac artery and lies midway
between the anterior superior iliac spine and the pubic tubercle.
The femoral artery is a continuation of the external iliac artery and lies midway
between the anterior superior iliac spine and the pubic symphysis.
(d) In the femoral triangle the femoral vein is on the lateral aspect of the femoral
artery.
In the femoral triangle the femoral artery is related laterally to the femoral nerve
and medially to the femoral vein and femoral canal.
(e) The femoral nerve is medial to the femoral artery in the femoral canal.
The femoral nerve is lateral to the femoral artery in the femoral canal.
25. Glenohumeral dislocation
(a) Anterior dislocations usually occur with excessive external rotation with the
arm in abduction.
(b) Recurrent anterior shoulder dislocation becomes increasingly frequent with
age.
Recurrent anterior dislocation is indirectly related to age. 80% of those below 20
years and 10% of those over 40 years.
(c) About 10% of people with anterior dislocations will also have compression
fractures of the upper aspect of the humeral head.
MCEM MCQ Anatomy

About 60% of people with anterior dislocations will also have compression
fractures of the upper aspect of the humeral head, this results in a flattened
segment referred to as a hatchet deformity( Hills-Sachs )
(d) Fractures of the greater tuberosity of the humerus occur in 15% of people with
anterior dislocation.
Also anterior dislocation is associated with fractures of the anterior rim of the
glenoid fossa.
(e) Posterior dislocations are typically associated with anteromedial fracture of the
humeral head.
Up to half of posterior dislocations are not recognised in the initial AP film.
26. Aortic Dissection
(a) 2/3rds of tears occur in the descending aorta
2/3 rds of tears occur in the ascending aorta. 1/5 th occur in descending.
(b) Mortality is highest at 2-3 days.
Mortality is highest in the first few hours.
(c) If the right coronary ostium is involved the ECG may give an inferior infarct
pattern.
If the right coronary ostium is involved the ECG may give an inferior infarct
pattern.
(d) Is associated with cocaine use, pregnancy and hypertension.
Other associations include marfan's, trauma, and coarctation.
(e) Medical therapy is indicated for uncomplicated dissection of descending aorta.
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And medical therapy may be considered for old stable dissections ( >2 weeks ),
and isolated arch dissections.
27. Central Venous Access:
(a) The internal jugular vein ( IJV ) runs antero-laterally in the carotid sheath,
parallel to the carotid artery and deep to the sternocleidomastoid muscle.
The internal jugular vein runs antero-laterally in the carotid sheath, parallel to the
carotid artery and deep to the sternocleidomastoid muscle.
(b) The needle to cannulate the IJV is inserted 0.5cm medial to the carotid artery.
The needle to cannulate the IJV is inserted 0.5cm lateral to the carotid artery.
(c) The needle is inserted 1 cm above the mid clavicular point to cannulate the
subclavian vein
The needle is inserted 1 cm below the mid clavicular point to cannulate the
subclavian vein
(d) The femoral vein is cannulated lateral to the femoral artery.
The femoral vein is cannulated 1 cm medial to the femoral artery.
(e) The right side of the neck should be used where possible to decrease the risk
of thoracic duct damage.
The right side of the neck should be used where possible to decrease the risk of
thoracic duct damage.
28. The Thorax:
(a) The inferior angle of the scapula is at T9
The inferior angle of the scapula is at T7
(b) The IVC goes through the diaphragm at T6
The IVC goes through the diaphragm at T8 ( along with the right phrenic nerve )
(c) The start of the arch of the aorta is at T2/T3
The start of the arch of the aorta is at T4/T5
(d) The sternum runs from T2 to T4
MCEM MCQ Anatomy

The sternum runs from T5 to T8
(e) The upper border of the liver is usually at T6
The upper border of the liver is usually at T6
29. Simple ankle strain(with damage to a few fibres of a ligament only)
(a) Slight swelling
Slight swelling may develop almost immediately after injury.
(b) Bruising
Bruising is associated with more severe injuries.
(c) Joint instability
It would require major damage to cause joint instability.
(d) Discomfort over the ligament
Discomfort over the ligament is often found with mild strains.
(e) Dramatic pain relief with cold compresses.
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Slight swelling develops immediately but settles to a large extent within a few
hours.Bruising occurs with a true or severe sprain. It would require major damage
to produce joint instability. Cold compresses may help reduce the swelling.
(a) Hip extension is performed by the femoral nerve.
Infeior gluteal performs hip extension.
(b) The femoral nerve is composed of L1 and L2 nerve roots.
The femoral nerve is composed of L2,L3 and L4.
(c) The inferior gluteal nerve is composed of L5,S1,S2 nerve roots.
The inferior gluteal nerve is composed of L5,S1,S2 nerve roots.
(d) Hip extension is performed by the gluteus maximus muscle.
Inferior gluteal nerve, L5,S1,S2 nerve roots.
(e) Hip abduction is performed by gluteus medius and minimus.
Superior gluteal nerve.
31. With regard to neck trauma the following are true:
(a) Penetrating injuries to the neck zone 1 extends from the clavicle to the cricoid
cartilage.
Zone 1 extends from the clavicles to the cricoid cartilage
(b) Penetrating injuries to the neck zone 2 extends from the cricoid cartilage to the
hyoid bone.
With regard to penetrating injuries to the neck zone 2 extends from the cricoid
cartilage to the angle of the mandible.
(c) Penetrating injuries to the neck zone 3 extends from the hyoid bone to the
base of the skull.
With regard to penetrating injuries to the neck zone 3 extends from the angle of
the mandible to the skull base.
(d) Breach of the platysma is an indication for emergency surgical exploration.
Breach of the platysma , evidence of vascular injury ,evidence of surgical
emphysema and haemodynamic instability due to major bleeding from a neck
wound are indications for emergency surgical exploration.
32. Myocardial Contusion
MCEM MCQ Anatomy

(a) Is usually caused by blunt trauma to the chest
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(c) On ECG may be represented by dysrhythmia's
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(d) On Trans Thoracic two dimensional echo may be represented by focal or

regional wall motion abnormalities
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(e) Dysrhythmias should be managed conservatively
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(c) The triceps is innervated by the radial nerve
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(d) The supinator reflex is innervated by the radial nerve
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(e) The knee jerk tests knee flexion
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Especially with fractures to sternum or anterior ribs

(b) On ECG may be represented by bundle branch block pattern
Manage as usual.
33. Tendon Reflexes
(a) The biceps are innervated by the radial nerve
Musculocutaneous, C5-6
(b) The biceps reflex main nerve roots are C5-6
Extension/Quadriceps/L3-4
34. The scaphoid bone
(a) The scaphoid only articulates with the radius, lunate, capitate, and trapezoid.
The scaphoid articulates with the radius, lunate, capitate, trapezoid, and
trapezium
(b) A small portion of the surface is covered by hyaline cartilage
Nearly the entire surface is covered by hyaline cartilage
(c) Vessels enter away from the sites of ligamentous attachment.
Vessels may enter only at the sites of ligamentous attachment
(d) The ulnar artery provides the blood supply to the scaphoid bone.
The dorsal and volar branches of the radial artery provide the blood supply to the
scaphoid
(e) The scaphoid lies at the ulnar border of the proximal carpal row
The scaphoid lies at the radial border of the proximal carpal row
The scaphoid lies at the radial border of the proximal carpal row, but its elongated
shape and position allow bridging between the 2 carpal rows because it acts as a
stabilizing rod. The scaphoid articulates with the radius, lunate, capitate,
trapezoid, and trapezium. As a result, nearly the entire surface is covered by
hyaline cartilage. Vessels may enter only at the sites of ligamentous attachment:
the flexor retinaculum at the tubercle, the volar ligaments along the palmar
surface, and the dorsal radiocarpal and radial collateral ligaments along the dorsal
ridge. The dorsal and volar branches of the radial artery provide the blood supply
to the scaphoid. The primary blood supply comes from the dorsal branch of the
MCEM MCQ Anatomy

radial artery, which divides into 2-4 branches before entering the waist of the
scaphoid along the dorsal ridge. The branches course volar and proximal within
the bone, supplying 70-85% of the scaphoid. The volar scaphoid branch also
enters the bone as several perforators in the region of the tubercle; these supply
the distal 20%-30% of the bone
35. Gastrointestinal Bleeding:
(a) About 40% of duodenal bleeds will re-bleed within 24 -48 hours.
About 10% of duodenal bleeds will re-bleed within 24 -48 hours.
(b) A Mallory weiss tear occurs in the distal oesophagus due to a tear in the
mucosa usually from repeated vomiting, but may also occur secondary to sneezing
A Mallory weiss tear occurs in the distal oesophagus due to a tear in the mucosa
usually from repeated vomiting, but may also occur secondary to sneezing
(c) In lower GI bleeding, not from haemorrhoids, the most common aetiologies are
adenomatous polyps.
In lower GI bleeding, not from haemorrhoids, the most common aetiologies are
diverticular disease and angiodysplasia.
(d) Angiodysplasia is more common in patients with aortic regurgitation.
Angiodysplasia is more common in patients with aortic stenosis.
(e) PUD causes about 30% of all upper GI bleeds.
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PUD causes about 60% of all upper GI bleeds

36. Ottawa Ankle Rules:Indication for X Ray
(a) Posterior edge of lateral malleolus bone tenderness.
Posterior edge of lateral malleolus bone tenderness is an indication for X Ray.
(b) Tip of lateral malleolus bone tenderness.
Tip of lateral malleolus bone tenderness is an indication for X Ray
(c) Posterior edge of medial malleolus bone tenderness.
Posterior edge of medial malleolus bone tenderness is an indication for X Ray.
(d) Tip of medial malleolus bone tenderness.
Tip of medial malleolus bone tenderness is an indication for X Ray.
(e) Base of the 5th metacarpal.
Base of the 5th metatarsal tenderness is an indication for X Ray.
http://www.bmj.com/cgi/content/full/326/7386/417#F1
37. The following are true with regard to lower vertebral levels:
(a) The bifurcation of the aorta occurs at the vertebral level of L4
The bifurcation of the aorta occurs at the vertebral level of L4
(b) The sacral dimples are at the vertebral levels of S2
The sacral dimples are at the vertebral levels of S2
(c) The posterior superior iliac spine is at the vertebral level of S1
The posterior superior iliac spine is at the vertebral level of S2
(d) The dural sac ends at the vertebral level of S1
The dural sac ends at the vertebral level of S2
(e) The rectum starts at the vertebral level of S3
The rectum starts at the vertebral level of S3
38. Eye Emergencies
MCEM MCQ Anatomy

(a) Herpes Simplex Virus can involve eyelids, conjunctiva and cornea.
HSV classically causes a dendritic epithelial defect. Treatment is with topical antivirals.
(b) Herpes Zoster Opthalmicus frequently involves a concurrent iritis
Herpes Zoster Opthalmicus is shingles in the distribution of the trigeminal nerve,
ocular involvement and frequently involves a concurrent iritis.
(c) Hyphema is not associated with rebleeding.
Rebleeding can occur about 3-5 days following the initial injury.
(d) Peri-orbital cellulitis is associated with painful eye movements.
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Orbital cellulitis is but peri-orbital cellulitis is not.

39. The Spinal Cord:
(a) There are 29 pairs of spinal nerves.
There are 31 pairs of spinal nerves.
(b) There are 8 pairs of cervical nerves.
There are 8 pairs of cervical nerves.
(c) There are 11 pairs of thoracic nerves.
There are 12 pairs of thoracic nerves.
(d) There are 4 pairs of sacral nerves.
There are 5 pairs of sacral nerves.
(e) There are 4 pairs of coccygeal nerves.
There is usually 1 pair of coccygeal nerves.
The spinal cord gives rise to 31 pairs of spinal nerves: 8 cervical, 12 thoracic, 5
lumbar, 5 sacral, and 1 coccygeal
40. Tract Dysfunction
(a) Corticospinal tract injury is characterised by contralateral motor deficits
Ipsilateral.Corticospinal tract injury is characterised by ipsilateral motor deficits.
(b) Spinothalamic tract injury is characterised by ipsilateral pain and temperature
sensation loss
Contralateral.Spinothalamic tract injury is characterised by contralateral pain and
temperature sensation loss.
(c) Posterior Column injury is characterised by ipsilateral proprioception loss
Posterior Column injury is characterised by ipsilateral proprioception loss
(d) Cervical Spine injury may present with hypotension and bradycardia
This is neurogenic shock due to loss of sympathetic tone.
(e) Cervical spine injuries may present with pain above but not below the clavicle
Cervical spine injuries may present with pain above but not below the clavicle
41. Anatomical considerations:
(a) The origin of the coeliac axis is at T8
The origin of the coeliac axis is at T12
(b) L3 is crossed by the transpyloric plane of addison ( half way between the
suprasternal notch and the symphysis pubis.)
L1 is crossed by the transpyloric plane of addison ( half way between the
suprasternal notch and the symphysis pubis.)
MCEM MCQ Anatomy

(c) The vagi pierce the diaphragm at T8 along with the oesophagus
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(b) Carotid artery aneursym
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(c) Posterior Communicating Artery Aneursym
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(d) Nasopharyngeal tumor spread
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(e) Wegeners Granulomatosis
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The vagi pierce the diaphragm at T10 along with the oesophagus
(d) The aortic opening in the diaphragm is anterior to the median arcuate ligament
and transmits the azygous and hemiazygous veins
The aortic opening in the diaphragm is posterior to the median arcuate ligament
and transmits the azygous and hemiazygous veins
(e) The aortic opening transmits the thoracic duct.
The aortic opening transmits the thoracic duct.
42. Carotid Sinus Syndrome may be caused by
(a) Trauma
Or any other cause of infection such as sinusitis or tuberculosis

43. The following is true with regard to rupture of the biceps tendon:
(a) It most often affects 20 to 40 year old men.
Rupture of the biceps most commonly affects 40 to 60 year olds.
(b) May cause a popping sound during some activity.
Or a sudden pain with a snapping sensation.
(c) Shoulder aching may be worse at night.
Or painful during repetitive or overhead movements
(d) May cause a visible mass between the shoulder and the elbow.
If not visible may well be palpable.
(e) The treatment of choice is surgical repair.
Of debatable value, but may be helpful in young athletic types.
44. Clavicle fractures
(a) Account for 1 in 20 adult fractures
(b) Are usually caused by a direct blow to the clavicle
They are usually caused by a fall onto the lateral clavicle.
(c) Non displaced fractures are almost always seen on AP views.
Non displaced fractures may be difficult to see on AP views and may need 20
degree ( Zanca ) views or 45 degree cephalic tilt.
(d) Lateral 1/3 rd of the clavicle are the most common site for fracture.
Middle 1/3 rd are the most common site for fracture and represents 80% of
fractured clavicles.( Allman classification )
(e) Non displaced lateral 1/3rd clavicular fractures should be treated
MCEM MCQ Anatomy

conservatively.
Displaced lateral 1/3rd fractures usually require operative intervention because
they have a high rate of non-union.
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(b) Class II shock usually do not have any mental anxiety
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(c) Class III patients usually have some anxiety
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(d) Class IV patients are usually alert and not confused
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(e) Class II patients are usually confused
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Non displaced medial 1/3rd fractures are treated conservatively while displaced
require orthopaedic referral. www.aafp.org/afp/20041115/1947.html
45. Haemorrhagic shock
(a) Class I patients usually do not have any mental anxiety
Class I-slight anxiety, Class II-more anxiety, Class III- anxious and sometimes
confused, class IV, confused and lethargic
46. Appreciation of the gross anatomy of the testis:
(a) The ductus deferens ascends on the medial side of the epididymis.
The ductus deferens ascends on the medial side of the epididymis.
(b) The epididymis is on the posterior aspect of the testes and is 6 m in length.
The epididymis is on the posterior aspect of the testes and is 6 m in length.
(c) The head of the epididymis lies on the lower pole of the testis where it is joined
by the efferent ducts.
The head of the epididymis lies on the upper pole of the testis where it is joined by
the efferent ducts.
(d) A hydrocele occurs when there is watery fluid between the parietal and visceral
layers of the tunica albuginea.
A hydrocele occurs when there is watery fluid between the parietal and visceral
(e) The testicular artery is a direct branch of the abdominal aorta which arises just
The testicular artery is a direct branch of the abdominal aorta which arises just
47. Traumatic Brain Injury
(a) The majority of cases of epidural haematoma have a loss of consciousness
followed by a lucid interval followed by neurological decline.
A minority, approximately 20%, of cases have this classical description.
(b) 80% of cases of epidural haematoma have a skull fracture that lacerates
meningeal arteries.
80% of cases of epidural haematoma have a skull fracture that lacerates
meningeal arteries.
(c) A fixed and dilated pupil because of a epidural haematoma is an early sign.
A fixed and dilated pupil because of a epidural haematoma is a late sign.
(d) Contralateral hemiparesis in epidural haematoma is an early sign.
MCEM MCQ Anatomy

Contralateral hemiparesis in epidural haematoma is a late sign.
(e) A common mechanism for subdural haematoma is an accelerationdeceleration injury
A common mechanism for subdural haematoma is an accelerationdeceleration
injury.
48. Vertebrae
(a) The vertebral arch is made up of two pedicles, two laminae, and seven
processes
The vertebral arch is made up of two pedicles, two laminae, and seven processes
(one spinous, two transverse, and four articular).
(b) Each disk consists of a peripheral annulus fibrosus and a central nucleus
pulposus
Each disk consists of a peripheral annulus fibrosus and a central nucleus pulposus
(c) The annulus fibrosus is composed of fibrocartilage
The annulus fibrosus is composed of fibrocartilage
(d) The nucleus pulposus is made of water and cartilage fibers.
The nucleus pulposus is made of water and cartilage fibers.
(e) With increasing age the proportion of fibrocartilage to fluid decreases.
With increasing age the porportion of fibrocartilage to water increases.
49. Testes, Epididymis and Spermatic Cord:
(a) The cremasteric fascia containing the cremasteric muscle is derived from the
rectus abdominis muscle.
The cremasteric fascia containing the cremasteric muscle is derived from the
internal oblique muscle
(b) The external spermatic fascia is derived from the aponeurosis of the
transversalis fascia.
The external spermatic fascia is derived from the aponeurosis of the external
oblique muscle
(c) The round ligament terminates in the fibrofatty tissue of the labium majus.
The round ligament terminates in the fibrofatty tissue of the labium majus.
(d) The deep inguinal ring transmits the genital branch of the genitofemoral nerve.
The deep inguinal ring transmits the genital branch of the genitofemoral nerve.
(e) The internal spermatic fascia is derived from the internal oblique.
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The internal spermatic fascia is derived from the transversalis fascia

50. Intracranial bleeding
(a) Extra dural haematoma is often due to bleeding from the anterior branch of the
middle meningeal artery after a temporal bone fracture
The classical history of this haematoma is one of an intial loss of consciousness
followed by a subsequent lucid period follwed by neurological deterioration.
(b) An acute rise in intracranial pressure may manifest as a falling pulse rate.
Cushings response is characterised by bradycardia and hypertension.
(c) An acute rise in intracranial pressure may manifest as a rising blood pressure.
Cushings response is characterised by bradycardia and hypertension.
(d) Amnesia for events >15min before the head injury is an indication for CT Brain
Scan.
Amnesia for events >30min before the head injury is an indication for CT Brain
Scan.
(e) An acute rise in intracranial pressure may manifest as a central respiratory
depression.
An acute rise in intracranial pressure may manifest as a central respiratory
MCEM MCQ Anatomy

depression.
Cushings response occurs with bradycardia and hypertension
51. Abdominal structures corresponding to vertebral levels:
(a) The renal arteries originate at the vetebral level of L1/2.
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(b) Solid organs such as liver resist cavitation more than softer tissues such as
lung
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(c) High velocity injuries usually have less bacterial contamination
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(d) Abdominal gunshot wounds invariably require laparotomy.
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(e) Cranial gunshot wounds invariably require ventilation.
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(b) The posterior half of the ear is supplied by branch of the trigeminal nerve.
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(c) The posterior part of the ear is supplied by 2 nerve branches derived from the
cervical plexus.
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(d) The vagus nerve has no role in the inervation of the ear.
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(e) The vagus nerve supplies the external auditory canal.
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The renal arteries originate at the vetebral level of L1/2.

(b) The spinal cord ends in adults at the level of L1/2.
The spinal cord ends in adults at the level of L1/2.
(c) The azygous and hemiazygous veins are formed at L4 vertebral level.
The azygous and hemiazygous veins are formed at L2 vertebral level
(d) The ligament of treitz is at the level of the upper border of the L4 vertebra.
The ligament of treitz is at the level of the upper border of the L2 vertebra.
(e) The umbilicus is at the vertebral level of L3/4.
The umbilicus is at the vertebral level of L3/4.
52. Gunshot Wounds:
(a) Temporary cavitation is caused by a sonic shock wave in high velocity injuries.
53. With regard to innervation of the ear

(a) The anterior half of the ear is supplied by the auriculotemporal nerve which is a
branch of the mandibular portion of the trigeminal nerve.
The anterior half of the ear is supplied by the auriculotemporal nerve which is a
branch of the mandibular portion of the trigeminal nerve.The posterior part of the
ear is supplied by 2 nerve branches derived from the cervical plexus.The vagus
nerve supplies the external auditory canal.The position for an ear block is where
the ear lobe attaches to the head.
54. Elbow Dislocation
(a) On lateral X Ray the radius and the ulna are most commonly displaced
posteriorly.
On lateral X Ray the radius and the ulna are most commonly displaced posteriorly.
MCEM MCQ Anatomy

(b) The most frequent neurological injury is to the median nerve.
The most frequent neurological injury is to the ulnar nerve.
(c) On clinical exam the olecranon process is commonly not prominent.
On clinical exam the olecranon process is commonly prominent.
(d) On clinical exam the elbow is commonly flexed at 90 degrees.
On clinical exam the elbow is commonly flexed at 45 degrees and the olecranon is
prominent.
(e) Vascular complications occur in about 10% of elbow dislocations.
The most common artery involved is the brachial artery.
55. Structure Function and Mechanics of the Vertebral Column:
(a) Flexion and extension of the vertebral column is extensive in the cervical and
thoracic regions but limited by the lumbar region.
Flexion and extension of the vertebral column is extensive in the cervical and
lumbar regions but limited by the thoracic region because of the rib cage.
(b) The cervical vertebrae normally have a posterior convexity while the thoracic
region has a posterior concavity.
The cervical vertebrae normally have a posterior concavity while the thoracic
region has a posterior convexity.
(c) There is normally 7 cervical vertebrae, 12 thoracic vertebrae, 5 lumbar
vertebrae, and 5 sacral vertebrae, and 4 coccygeal vertebrae.
There is normally 7 cervical vertebrae, 12 thoracic vertebrae, 5 lumbar vertebrae,
and 5 sacral vertebrae, and 4 coccygeal vertebrae.
(d) Rotation ( twisting movement ) of the body is least extensive in the cervical
region.
Rotation of the body is least extensive in the lumbar region.
(e) Lateral flexion of the body is restricted by the cervical section of the vertebral
column
Lateral flexion of the body is restricted by the thoracic section of the vertebral
column
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MCEM MCQ Anatomy

1. Maxillofacial radiographs
(a) Orthopantomogram view can be used to assess the frontal bones False
?OPG is used to assess the mandible
(b) Submentovertical projection is used to assess the zygomatic arch True
?
(c) Occiptomental views are used to assess the maxilla True
?Occiptomental views are used to assess the maxilla, orbital floors and zygomatic arches
(d) Occipitomental views are used to assess the orbital floors True
(e) Occipitomental views are used to assess the zygomatic arches True
2. Surface Anatomy:
(a) The pharynx becomes the oesophagus at C6 True

?The pharynx becomes the oesophagus at C6
(b) C7 is the first clearly palpable spinous process. True
?C7 is the first clearly palpable spinous process.
(c) The superior border of the scapula is at T3 False
?The superior border of the scapula is at T2
(d) The suprasternal notch is at the level of T2/3 True
?The suprasternal notch is at the level of T2/3
(e) The end of the oblique fissure of the lung is at the spine of T3 True
?The end of the oblique fissure of the lung is at the spine of T3
3. Surface Anatomy of the Anterior Forearm:
(a) The brachial artery divides into the radial and ulnar arteries just below the line of the elbow joint. True
?The brachial artery divides into the radial and ulnar arteries just below the line of the elbow joint.
(b) The radial artery lies in a groove between the flexor carpi radialis and the anterior border of the radius.
True
?The radial artery lies in a groove between the flexor carpi radialis and the anterior border of the radius.
The radial artery lies in a groove between the flexor carpi radialis and the anterior border of the radius.
(c) The radial artery can be palpated on the lateral side of the trapezium in the anatomical snuff box. False
?The radial artery can be palpated on the lateral side of the scaphoid in the anatomical snuff box.
(d) In the area of the wrist and hand the ulnar artery is covered by the palmer aponeurosis. True
?In the area of the wrist and hand the ulnar artery is covered by the palmer aponeurosis.
(e) The pulsations of the ulnar artery are recognised lateral to the pisiform bone. True
?The pulsations of the ulnar artery are recognised lateral to the pisiform bone
MCEM MCQ Anatomy

4. Radial Head Fractures
(a) Radial head fractures are the most common fractures of the elbow True
?Radial head fractures are the most common fractures of the elbow
(b) The radial head articulates with the trochlea False
?The radial head articulates with the capitellum.
(c) The radial head serves as a stabiliser against forces away from the midline. True
?The radial head serves as a stabiliser against valgus stress.
(d) Radial head fractures are usually the result of a fall on an outstretched hand causing the radial head to
be driven into the trochlea. False
?Radial head fractures are usually the result of a fall on an outstretched hand causing the radial head to be
driven into the capitellum.
(e) Are associated with medial epicondyle avulsion fractures. True
?This is secondary to valgus stress.
5. Anatomical Considerations of the thoracic vertebrae:
(a) The start of the arch of the aorta is at T4/T5 True

?The start of the arch of the aorta is at T4/T5
(b) The sternum runs from T5 to T8 True
?The sternum runs from T5 to T8
(c) The upper border of the liver is usually at T9 False
?The upper border of the liver is usually at T6
(d) The inferior angle of the scapula is at T3 False
?The inferior angle of the scapula is at T7
(e) The IVC goes through the diaphragm at T8 True
?The IVC goes through the diaphragm at T8 ( along with the right phrenic nerve )
6. the ulnar nerve is interrupted at the wrist the following muscles are not innervated.
(a) Palmaris brevis . True

?Palmaris brevis is innervated by the superficial terminal branch of the ulnar nerve in the hand.
(b) Opponens pollicis False
?Opponens pollicis is innervated by the median nerve.
(c) Flexor pollicis brevis False
?Flexor pollicis brevis is innervated by the median nerve.
(d) Abductor pollicis brevis False
?Abductor pollicis brevis is innervated by the median nerve.
(e) Flexor carpi ulnaris False
?Flexor carpi ulnaris is innervated by a branch of the ulnar nerve in the forearm.
MCEM MCQ Anatomy

7. Neuroanatomy
(a) The fibers of the pyramids cross in the pons. False

?The fibers of the pyramids cross in the medulla.The crossing event is called the decussation of the
pyramids
(b) The cerebral peduncles largely contain motor fibers. True
?The cerebral peduncles largely contain motor fibers.
(c) Motor and somatosensory information travel through the anterior limb of the internal capsule. False
?Motor and somatosensory information travel through the posterior limb of the internal capsule.
(d) In the motor cortex the lateral side of the gyrus controls the hands and face. True
?In the motor cortex, the body is mapped out across the extent of the gyrus. Control of the feet lies near the
midline at the top of the gyrus, whereas the lateral side of the gyrus controls the hands and face.
8. The following headaches usually have associated focal abnormal neurology
(a) Migraine False

?Possible but not usual
(b) Ca channel blocker associated headache False
?
(c) Nitrates associated headache False
?
(d) CO poisoning headache False
?
(e) Temporal Arteritis False
?
Other headaches without associated neurology include tension, and analgesic
9. During initial management of a multiply injured patient:
(a) Shock management is the first priority. False

?
(b) Cervical spine control is usually necessary. True
?Cervical spine control is usually necessary.
(c) External haemorrhage should be ignored. False
?
(d) Pulse oximetry is usually unhelpful. False
?The results of pulse oximetry should be interpreted with particular caution in the presence of abnormal
haemoglobins(the pulse oximetry reading represents a summation of oxyhemoglobin and
carboxyhemoglobin and in cases of carbon monoxide poisoning or in chronic, heavy smokers, a falsely
reassuring pulse oximetry reading may mask arterial desaturation), nail polish, deeply pigmented skin,
hypoperfusion, anemia, venous congestion, or when certain vital dyes (such as methylene blue,
indocyanine green, fluorescein, indigo carmine, and isosulfan blue) are used for clinical purposes.
(e) Ischaemic limbs demand immediate attention. False
?
MCEM MCQ Anatomy

10. Chest drain insertion is usually indicated in patients with the following conditions:
(a) Mediastinal traversing wounds. True

?
(b) Flail chest. True
?Flail chest occurs when three or more adjacent ribs are each fractured in two places, creating one floating
segment comprised of several rib sections and the soft tissues between them. This unstable section of
chest wall exhibits paradoxical motion (ie, it moves in the opposite direction of the uninjured, normalfunctioning chest wall) with breathing, and is associated with significant morbidity from pulmonary
contusion. Abnormal motion can be difficult to detect making the diagnosis difficult. Initial management of
flail chest consists of oxygen and close monitoring for early signs of respiratory compromise, ideally using
both pulse oximetry and capnography in addition to clinical observation. Use of noninvasive positive airway
pressure by mask may obviate the need for endotracheal intubation in alert patients. Patients with severe
injuries, respiratory distress, or progressively worsening respiratory function require endotracheal intubation
and mechanical ventilatory support.
(c) Open pneumothorax. True
?
(d) Ruptured diaphragm. False
?
(e) Surgical emphysema. False
?
11. Major Trauma:
(a) Pelvic fractures in children are rare and clinically apparent, making the routine screening pelvic X Ray
obsolete. True
?
(b) Hypertonic saline is beneficial in hypotensive patients with head injury. False
?
(c) Steroids are beneficial in patients with head injury and GCS <15 False
?http://www.thelancet.com/journals/lancet/article/PIIS0140673604171882/abstract.
(d) Patients intubated without the need for anaesthetic drugs had a survival rate of about 2% False
?
(e) A post traumatic head injury seizure is an indication to request a CT brain scan immediately according
to the NICE guidelines. True
?http://www.nice.org.uk/nicemedia/pdf/CG56QuickRedGuide.pdf
One New Zealand study of 347 children who had a pelvic X Ray found only 1 fracture and this fracture was
clinically apparent. The authors recommend not X Raying. In the CRASH trial steroids in patients with head
injury showed more harm than good.
http://www.thelancet.com/journals/lancet/article/PIIS0140673604171882/abstract
MCEM MCQ Anatomy

12. Regarding fracture classifications:
(a) The Neer classification refers to distal radial fractures. False

The Neer classification refers to proximal humeral fractures.
(b) The Frykman classification refers to proximal humeral fractures. False
The Frykman classification refers to distal radial fractures.
(c) The Schatzker classification refers to tibial plateau fractures. True
The Schatzker classification refers to tibial plateau fractures.
(d) Type II is the most common type of Salter-Harris fracture presentations. True
Type II is the most common type of Salter-Harris fracture presentations.
13. The glossopharyngeal nerve (CN IX):
(a) Arises in the pons. False

?The glossopharyngeal nerve is mainly sensory. It arises in the medulla.
(b) Leaves the skull through the jugular foramen True
?The glossopharyngeal nerve leaves the skull through the jugular foramen along with the vagus and
accessory nerve.
(c) Is the efferent pathway of the gag reflex False
?Sensory fibers provide sensation to the tonsillar fossa and pharynx ( the afferent pathway of the gag
reflex) and taste to the posterior 2/3 rd's of the tongue.
(d) Supplies taste fibers to the anterior two-thirds of the tongue False
?Sensory fibers provide sensation to the tonsillar fossa and pharynx ( the afferent pathway of the gag reflex
) and the taste to the posterior 2/3 rd's of the tongue.
(e) Supplies the stylopharyngeal muscle. True
?Motor fibers supply the stylopharyngeus muscle, autonomic fibers supply the parotid gland, and a sensory
branch supplie the carotid sinus.
14. The following statements are true
(a) The median nerve supplies the interossei of the hand False
?Ulnar
(b) The radial nerve supplies the abductor pollicis brevis False
?The radial nerve does not supply any of the intrinsic muscles of the hand
(c) The ulnar nerve supplies sensation to the one and a half ulnar digits True
?
(d) The extensor muscles of the forearm are supplied by the radial nerve True
?
(e) The biceps muscle is supplied by the musculocutaneous nerve True
?
MCEM MCQ Anatomy

15. The following are true in relation to common root compression syndromes produced by lumbar disc
disease:
(a) An S1 root lesion will produce weakness of plantar flexion of the ankle and toes. True
?An S1 root lesion will produce weakness of plantar flexion of the ankle and toes.
(b) An S1 root lesion will cause loss of the knee jerk reflex. False
?An S1 root lesion will cause loss of the ankle jerk reflex.
(c) An L4 root lesion will cause sensory loss at the anteromedial shin. True
?An L4 root lesion will cause sensory loss at the anteromedial shin.
(d) An L5 root lesion will cause sensory loss over the sole of the foot. False
?An L5 root lesion will cause sensory loss over the dorsum of the foot and anterolateral shin while an S1
root lesion will cause sensory loss over the sole of the foot.
16. The Ear
(a) The cochlea contains the auditory sensory receptors. True

?The cochlea contains the auditory sensory receptors and the vestibular labyrinth contains the balance
receptors
(b) The vestibular labyrinth contains the balance receptors. True
?The cochlea contains the auditory sensory receptors and the vestibular labyrinth contains the balance
receptors
(c) Blood supply to the inner ear is from the internal carotid artery. False
?Blood supply to the inner ear is from the vertebrobasilar system.
(d) The anterior vestibular artery to the cochlea False
?The anterior vestibular artery provides the blood supply to the anterior and horizontal semicircular canals
but not to the cochlea
(e) The anterior vestibular artery provides the blood supply to the anterior and horizontal semicircular
canals. True
?The anterior vestibular artery provides the blood supply to the anterior and horizontal semicircular canals
but not to the cochlea
17. Colles Fracture
(a) Is a fracture of the radius within 1 cm of the wrist. False

?Colles fracture is a fracture of the radius within 2.5 cm of the wrist.
(b) The distal fragment is displaced anteriorly. False
?The distal fragment is displaced posteriorly and with radial displacement.
(c) The angulation of the distal radius normally has a 5 degree forward tilt on the poximal carpal bones as
seen on the lateral X Ray ( i.e in peole without a fracture ) True
?The angulation of the distal radius normally has a 5 degree forward tilt on the poximal carpal bones as
seen on the lateral X Ray ( i.e in peole without a fracture )
(d) Colles fracture is associated with flexor pollicis longus rupture in the weeks following injury. False
?Colles fracture is associated with extensor pollicis longus tendon rupture in the weeks following the injury.
(e) Colles fracture usually follows a fall onto a flexed wrist False
?Colles fracture usually follows a fall onto an outstretched hand. Smith's fracture usually follows a fall onto
a flexed wrist.
MCEM MCQ Anatomy

18. Radiograph Interpretation
(a) The right heart border is formed by the outer border of the right ventricle. False
?The right heart border is formed by the outer border of the right atrium.
(b) The left heart border is formed by the outer border of the left ventricle. True
?The left heart border is formed by the outer boder of the left ventricle.
(c) The left margin of the right ventricle lies about a thumbs breath in from the left heart border. True
?The left margin of the right ventricle lies about a thumbs breath in from the left heart border and on the
surface of the heart this is marked by the left anterior descending artery.
(d) Valve calcification is best seen on the AP view. False
?Valve calcification is best seen on the lateral view as on the AP view valve calcification cannot be
visualised over the spine.
(e) A large pulmonary artery will cause hilar enlargement. True
?A large pulmonary artery will cause hilar enlargement as will lymphadenopathy.
19. The facial nerve
(a) The nerve emerges on the anterior surface of the brain between the pons and the medulla and it enters
the internal acoustic meatus with the vestibulocochlear nerve. True
?The nerve emerges on the anterior surface of the brain between the pons and the medulla and it enters
the internal acoustic meatus with the vestibulocochlear nerve.
(b) The greater petrosal nerve arises from the nerve at the geniculate ganglion. True
?The greater petrosal nerve contains taste fibers from the palate. It also contains preganglionic
parasympathetic fibres that synapse in the pterygopalatine ganglion. The postganglionic fibers are
secretomotor to the lacrimal gland and the glands of the nose and palate.
(c) Passes through the posterior fossa. True
?
(d) On reaching the medial wall of the middle ear the nerve swells to form the sensory geniculate ganglion.
True
?
(e) Emerges from the temporal bone through the stylo-mastoid foramen. True
?
The facial nerve arises in the medulla and emerges between the pons and medulla. It then passes through
the posterior fossa and runs through the middle ear before emerging from the stylo-mastoid foramen and
running through the parotid.
20. The Forearm:
(a) The radial artery can be palpated on the medial side of the scaphoid in the anatomical snuff box. False
?The radial artery can be palpated on the lateral side of the scaphoid in the anatomical snuff box.
(b) The pulsations of the ulnar artery are recognised lateral to the lunate bone. False
?The pulsations of the ulnar artery are recognised lateral to the pisiform bone
(c) The radial artery lies in a groove between the flexor digitorum profundus and the anterior border of the
radius. False
?The radial artery lies in a groove between the flexor carpi radialis and the anterior border of the radius.
(d) In the area of the wrist and hand the ulnar artery is covered by the palmer aponeurosis. True
MCEM MCQ Anatomy

?In the area of the wrist and hand the ulnar artery is covered by the palmer aponeurosis.
(e) The brachial artery divides into the radial and ulnar arteries just below the distal third of the humerus.
False
?The brachial artery divides into the radial and ulnar arteries just below the line of the elbow joint.
21. With regard to innervation of the scalp
(a) The frontal part of the scalp is innervated by branches of the opthalmic part of the trigeminal nerve.
True
(b) The frontal part of the scalp is innervated by the supraorbital and supratrochlear nerves. True
(c) The posterior part of the scalp is innervated by branches of the first division of the trigeminal nerve
False
(d) The posterior part of the scalp is innervated by branches of the cervical plexus. True
(e) The cervical plexus plays a role in innervation of the posterior and lateral scalp. True
The frontal part of the scalp is innervated by the supraorbital and supratrochlear nerves which are branches
of the first division of the trigeminal nerve.The posterior part of the scalp is innervated by branches of the
cervical plexus, more specifically the greater and lesser occipital nerves. The cervical plexus innervates the
lateral scalp through the lesser occipital nerve.
22. Muscles of the hand
(a) Flexor pollicis brevis flexes the MCP joint of the thumb. True
(b) Flexor pollicis brevis is innervated by median nerve True
This is usually the case however may also be innervated by the deep branch of the ulnar nerve
(c) Flexor pollicis longus flexes proximal phalanx of thumb False
Flexor pollicis longus flexes distal phalanx of thumb
(d) Extensor pollicis longus extends the IP and MCP joints of the thumb True
?
(e) Extensor pollicis brevis forms anterior border of the anatomical snuff box. True
Extensor pollicis brevis forms anterior border of the anatomical snuff box and the posterior border of the
snuffbox is the tendon of the extensor pollicis longus.
23. Penetrating injuries of the diaphragm
(a) The arching domes of the diaphragm highest point is the level of the 6th rib False
(b) If a penetrating injury is just below the level of the nipples one should not be suspicious of a penetrating
injury to the diaphragm False
MCEM MCQ Anatomy

(c) The left dome of the diaphragm is higher than the right dome in normal people. False
(d) The right dome of the diaphragm is higher than the left dome in normal people. True
(e) The right dome of the diaphragm is more likely to suffer a penetrating injury. False
The arching domes of the diaphragm can reach the level of the 5th rib.If a penetrating injury is just below
the level of the nipples one should be suspicious of a penetrating injury to the diaphragm
24. Occlusion of the anterior cerebral artery causes
(a) Paralysis of the opposite leg True

?
(b) Perseveration True
?
(c) Urinary incontinence True
?
(d) Grasp reflex in the opposite hand True
?
(e) Wernickes(receptive/fluent) dysphasia False
?
25. In the alert patient with evidence of blunt abdominal trauma:
(a) Peritoneal lavage is helpful if the patient is stable. True

?100,000 RBC/mm3 or 500 WBC/mm3 is considered a positive peritoneal lavage and reflects intraabdominal bleeding.
(b) Peritoneal lavage is indicated if the patient is unstable. False
?The patient is likely to need a laparotomy if there has been abdominal trauma and he/she is
haemodynamically unstable.
(c) With FAST scanning free fluid visible in the abdomen implies at least 500ml of fluid. True
?With FAST scanning free fluid visible in the abdomen implies at least 500ml of fluid.
(d) CT Scanning will visualise retroperitoneal injuries well True
?CT scanning may miss diaphragmatic injury and many visceral injuries but will detect solid organ damage
or intraperitoneal blood.
(e) Laparotomy is usually necessary in the shocked patient True
?The patient is likely to need a laparotomy if there has been abdominal trauma and he/she is
haemodynamically unstable.
MCEM MCQ Anatomy

26. Ottawa ankle rules: The following require X Ray
(a) Tenderness at the base of the 5th metatarsal. True

?
(b) Bone tenderness along the distal 6 cm of the posterior edge of the tibia or tip of the medial malleolus
True
?
(c) Bone tenderness along the distal 6 cm of the posterior edge of the fibula or tip of the lateral malleolus
True
?
(d) Bone tenderness at the navicular bone (for foot injuries). True
?
(e) Pregnancy is an exclusion criteria. True
?Along with children and those with diminished ability to follow the test.
X-rays are only required if there is bony pain in the malleolar or midfoot area, and any one of the following:
Bone tenderness along the distal 6 cm of the posterior edge of the tibia or tip of the medial malleolus Bone
tenderness along the distal 6 cm of the posterior edge of the fibula or tip of the lateral malleolus Bone
tenderness at the base of the fifth metatarsal (for foot injuries). Bone tenderness at the navicular bone (for
foot injuries). An inability to bear weight both immediately and in the emergency department for four steps.
Certain groups are excluded, in particular children (under the age of 18), pregnant women, and those with
diminished ability to follow the test (for example due to head injury or intoxication).
27. Mandibular Fractures
(a) Usually occur on one side of the mandible only False

?
(b) The most common area of fracture is the angle of the mandible True
(c) May present with bony crepitus True
(d) May present with malocclusion True
(e) May present with limited ROM True
28. The following are true
(a) Biceps is innervated by musculocutaneous True

?
(b) Brachioradialis is innervated by musculocutaneous False
?By radial nerve
(c) Elbow flexion is initiated by nerve roots C5 and C6 True
?
(d) Triceps are innervated by C7 True
?
(e) Finger flexion is mediated by the radial nerve False
?Median and ulnar
MCEM MCQ Anatomy

29. The Hand
(a) The median nerve enters the hand through the carpal tunnel, deep to the flexor retinaculum, between
the tendons of the flexor digitorum superficialis and the flexor carpi radialis. True
?The median nerve enters the hand through the carpal tunnel, deep to the flexor retinaculum, between the
tendons of the flexor digitorum superficialis and the flexor carpi radialis.
(b) To anaesthetise the median nerve local anaesthetic is injected between the tendon's of the flexpr carpi
radialis and palmaris longus. True
?To anaesthetise the median nerve local anaesthetic is injected between the tendon's of the flexpr carpi
radialis and palmaris longus.
(c) At the wrist the ulnar nerve is blocked by injecting local anaesthetic between the palmaris longus and
the flexor carpi ulnaris False
?At the wrist the ulnar nerve is blocked by injecting local anaesthetic between the ulnar artery and the
flexor carpi ulnaris.
(d) The ulnar nerve supplies cutaneuos sensation to the volar surface of the middle finger. False
?The ulnar nerve supplies cutaneuos sensation to the volar surface of the little finger and the medial half of
the ring finger.
(e) About 5 ml's of 2% lignocaine is required to anaesthetise the ulnar nerve. False
?
30. Left common carotid artery
(a) Lies postero-laterally to the left vagus nerve in the neck. False
The left common carotid artery lies antero-medial to the left vagus nerve in the neck
(b) Lies anteriorly to the prevertebral fascia in the neck. True
The left common carotid artery lies anteriorly to the prevertebral fascia in the neck.
(c) Gives off the left inferior thyroid artery. False
The left thyroid artery is a branch of the left thyrocervical trunk of subclavian
(d) Is a direct branch from the aortic arch. True
The left common carotid artery is a direct branch from the aortic arch.
31. Haemorrhagic Shock
(a) Pulse <100 is consistent with class I shock True

?
(b) Pulse 100-120 is consistent with class II shock True
?
(c) Pulse 120-140 is consistent with class III shock True
?
(d) Pulse >140 is consistent with class IV shock True
?
(e) Pulse 120-140 is consistent with class IV shock False
?
ATLS classification. <100 class I, <120 class II, <140 class III, >140 class IV
MCEM MCQ Anatomy

32. The Lumbar Plexus:
(a) The femoral nerve originates from the lumbar plexus from L2, L3 and L4. True
?The femoral nerve originates from the lumbar plexus from L2, L3 and L4.
(b) The obturator nerve originates from L1 and L2 and supplies the adductor muscles of the thigh. False
?The obturator nerve originates from L2, L3 and L4 and supplies the adductor muscles of the thigh.
(c) The femoral nerve supplies the skin on the posterior aspect of the leg and foot. False
?The femoral nerve supplies the skin on the medial side of the leg and foot.
(d) The iliohypogastric nerve supplies the cremaster muscle. False
?The genitofemoral nerve supplies the cremaster muscle.
(e) The femoral nerve supplies the skin on the medial surface of the thigh only. False
?The femoral nerve supplies the skin on the anterior surface of the thigh.The obturator nerve innervates the
adductors of the thigh and the skin on the medial surface of the thigh.
33. Lower vertebral levels:
(a) The dural sac ends at the vertebral level of S3 False

?The dural sac ends at the vertebral level of S2
(b) The rectum starts at the vertebral level of S1 False
?The rectum starts at the vertebral level of S3
(c) The bifurcation of the aorta occurs at the vertebral level of L5 False
?The bifurcation of the aorta occurs at the vertebral level of L4
(d) The sacral dimples are at the vertebral levels of S1 False
?The sacral dimples are at the vertebral levels of S2
(e) The posterior superior iliac spine is at the vertebral level of S2 True
?The posterior superior iliac spine is at the vertebral level of S2
34. Compartment syndrome:
(a) The pain is characteristically mild. False

?
(b) The pain is characteristically well localised. False
?
(c) Palpation of the affected compartment will exacerbate the pain. True
?Palpation of the affected compartment will exacerbate the pain.
(d) Passive stretching of muscles in the affected compartment will exacerbate the pain. True
?Passive stretching of muscles in the affected compartment will exacerbate the pain.
(e) Paraesthesia is a feature before pain. False
?
The pain is severe and poorly localised.Palpation of the affected compartment will exacerbate the
pain.Passive stretching of muscles in the affected compartment will exacerbate the pain.Paraesthesia is a
feature after pain.
MCEM MCQ Anatomy

35. Lymphatic drainage of the thoracic wall.
(a) The skin drains to the axillary lymph nodes. True

(b) The intercostal spaces drain to the internal thoracic nodes. True
(c) The posterior spaces drain to the posterior intercostal nodes. True
(d) The posterior intercostal spaces drain to the para aortic nodes True
(e) The skin on the posterior surface drains to the para-aortic nodes False
The skin drains to the axillary lymph nodes.The intercostal spaces drain forwards to the internal thoracic
nodes and backwards to the posterior intercostal nodes and the para aortic nodes.
36. Characteristic features of repetitive strain injury:
(a) Pain felt deep in the wrist. True

?Pain felt deep in the wrist radiating to forearm and shoulder is a characteristic feature of repetitive strain
injury.
(b) Marked oedema of fingers and hand. False
?Subjective feeling of swelling but nothing to find on examination.
(c) Symptoms worse at night False
?Worsen with work and improve with rest. Pain initially clears at night but can become constant.
(d) Raised ESR. False
?No clinical signs. X Ray and bloods are normal.
(e) Good response to NSAIDs. False
?Not of great help.
(a) The dorsal scapular nerve is a branch of C7. False

?The dorsal scapular nerve is a branch of C5.
(b) The medial cord supplies the extensor structures on the posterior aspect of the limb. False
?The posterior cord supplies the extensor structures on the posterior aspect of the limb.
(c) The anterior division of the lower trunk forms the medial cord. True
?The anterior division of the lower trunk forms the medial cord.
(d) The posterior cord may contain neurons from all the spinal nerves contributing to the brachial plexus
True
?The posterior cord may contain neurons from all the spinal nerves contributing to the brachial plexus.
(e) In the axilla the posterior divisions unite to form the lateral cord False
?In the axilla the posterior divisions unite to form the posterior cord
MCEM MCQ Anatomy

38. The Vertebral Column:
(a) Lateral flexion of the body is restricted by the thoracic section of the vertebral column. True
?Lateral flexion of the body is restricted by the thoracic section of the vertebral column because of the ribs.
(b) Rotation ( twisting of the body ) of the body is least extensive in the lumbar region. True
?Rotation of the body is least extensive in the lumbar region.
(c) Flexion and extension of the vertebral column is extensive in the cervical and thoracic regions but
limited by the lumbar region. False
?Flexion and extension of the vertebral column is extensive in the cervical and lumbar regions but limited
by the thoracic region.
(d) The cervical vertebrae normally have a posterior convexity while the thoracic region has a posterior
concavity. False
?The cervical vertebrae normally have a posterior concavity while the thoracic region has a posterior
convexity.
(e) There is normally 7 cervical vertebrae, 12 thoracic vertebrae, 5 lumbar vertebrae, and 5 sacral
vertebrae, and 4 coccygeal vertebrae. True
?There is normally 7 cervical vertebrae, 12 thoracic vertebrae, 5 lumbar vertebrae, and 5 sacral vertebrae,
and 4 coccygeal vertebrae.
39. The thorcic spine:
(a) Has an increased amount of flexibility afforded by it's articulation with the rib cage. False
?The rib cage makes the thoracic spine more inflexible and more rigid.
(b) The thorcic spine is the most commonly injured part of the spine. False
?The thoracic spine is among the least frequently injured parts of the spine.
(c) The spinal canal is wider than that found in the cervical spine. False
?The spinal canal is narrower in the thoracic spine than that found in the cervical or lumbar spine.
(d) When spinal cord injury does occur they are mostly neurologically complete. True
?Because of the high ratio of spinal cord to spinal canal in the thoracic spine when spinal cord injury does
occur it is usually complete.
(e) The thoracolumbar junction (T11-L2) is considered a transitional zone between the fixed thoracic and
mobile lumbar regions True
?The thoracolumbar junction (T11-L2) is considered a transitional zone between the fixed thoracic and
mobile lumbar regions
40. The following muscles and nerve root supply are correctly paired:
(a) Deltoid:C5 True

?C5 is the nerve root for shoulder abduction by the deltoid muscle.
(b) Wrist Extensors:C6 True
?C6 is the nerve root for wrist extension.
(c) C7:Elbow Extension True
?C7 is the nerve root for elbow extension.
(d) T1:Abductor Digiti Minimi True
?T1 is the nerve root for little finger abduction by abductor digiti minimi.
MCEM MCQ Anatomy

41. Hip Fractures
(a) Extracapsular fractures are more likely to compromise blood supply to the femoral head than
intracapsular fractures. False
?
(b) Isolated femoral head fractures are most commonly associated with hip dislocations. True
?
(c) Non displaced neck fractures are treated with pin fixation. True
?
(d) Displaced fractures are treated with open reduction or prosthesis placement. True
?
(e) Overall mortality for intertrochanteric hip fractures is 50% False
?Overall mortality for intertrochanteric hip fractures is 10 to 30%.
Hip fracture incidence doubles for each decade after 50. Hip fracture incidence is 3 to 4 times higher in
women than in men. The affected leg in a hip fracture is classically shortened and externally rotated.
Intracapsular hip fractures involve the femoral head and femoral neck. Extracapsular hip fractures may be
intertrochanteric or subtrochanteric. Intracapsular fractures are more likely to compromise blood supply to
the femoral head than extracapsular fractures. Isolated femoral head fractures are most commonly
associated with hip dislocations. Non displaced neck fractures are treated with pin fixation. Displaced
fractures are treated with open reduction or prosthesis placement. Intertrochanteric fractures are classed as
stable or unstable. stable fractures are those which the medial cortices of the femoral neck and the femoral
fragment abut. Overall mortality for intertrochanteric hip fractures is 10 to 30%.
42. Classification of shock
(a) Class I shock is when blood loss is <10% of blood volume False
?
(b) Class II shock is when blood loss is <20% of blood volume False
?
(c) Class III shock is when 20-40% of blood volume is lost False
?
(d) Class IV shock is when >40% blood volume is lost True
?
(e) Class V shock is when >50% of blood volume is lost False
?
Class I = <15%, Class II = <30%, Class III = <40%, Class IV = >40%
MCEM MCQ Anatomy

43. NICE Guideline: Selection of Adults for CT Brain
(a) GCS < 13 when first assessed in ED CT brain should be requested immediately according to the NICE
guidelines after head injury. True
?GCS < 13 when first assessed in ED CT brain should be requested immediately
(b) If GCS < 15 when assessed 2 hours after presentation in ED CT brain should be requested. True
?If GCS < 15 when assessed 2 hours after presentation in ED CT brain should be requested.
(c) A suspected skull fracture is not an indication to request a CT Brain scan. False
?A suspected skull fracture is an indication to request a CT Brain scan.
(d) 'Panda' eyes are not an indication to request a CT Brain scan False
?'Panda' eyes is an indication to request a CT brain scan as this is evidence of a fracture at the skull base.
(e) A collection of blood in the middle ear space is not an indication to request a CT Brain scan. False
?Haemotympanum is an indication to request a CT Brain scan as this is evidence of a fracture at the skull
base.
44. Openings in the diaphragm
(a) The aortic opening lies anterior to the body of T10 False
The aortic opening lies anterior to the body of T12.The aortic opening transmits the aorta,the thoracic duct
and the azygous vein
(b) The aortic opening transmits the aorta,the thoracic duct, the azygous vein, and the vagus nerve. False
The aortic opening transmits the aorta,the thoracic duct and the azygous vein. The oesophageal opening
transmits the vagi.
(c) The esophageal opening is at the level of T12 False
The esophageal opening is at the level of T10.
(d) The esophageal opening transmits the phrenic nerve False
The esophageal opening transmits the vagi at T10. The right phrenic nerve penetrates the diaphragm with
the IVC while the left phrenic nerve penetrates on it's own.
(e) The caval opening transmits the inferior vena cava at the level of T8 True
The caval opening transmits the inferior vena cava at the level of T8.
The aortic opening lies anterior to the body of T12.The aortic opening transmits the aorta,the thoracic duct
and the azygous vein.The esophageal opening transmits the vagus nerve
45. With regard to the nervous system
(a) Dorsal columns carry proprioception and vibration sense True

Dorsal columns ( Posterior Columns ) carry proprioception and vibration sense and decussate in the
brainstem.
(b) The dorsal columns decussate in the medulla True
The dorsal columns decussate in the medulla
(c) The sensory cortex is in the parietal lobe True
The sensory cortex is in the parietal lobe
(d) The spinothalamic tract decussates at the level of the brainstem. False
The spinothalamic tract is a sensory pathway originating in the spinal cord that transmits information about
pain, temperature, itch and crude touch to the thalamus. The pathway decussates at the level of the spinal
MCEM MCQ Anatomy

cord, rather than in the brainstem. The posterior column-medial lemniscus pathway and corticospinal tract
decussate in the brainstem.
(e) The muscles of mastication are innervated by the facial nerve False
The muscles of mastication are innervated by the trigeminal nerve ( CN V )More specifically, they are
innervated by the mandibular branch, or V3
The dorsal columns carry proprioception and vibration sense. From the leg they ascend in gracilis fasicles
and from the arm they ascend as the cuneatus fasiciles.In the caudal medulla they synapse and decussate
in the internal arcuate fibres.They then ascend to the ventroposterolateral(VPL) nucleas of the thalamus
and from there to the sensory cortex of the parietal lobe.
46. The sternal angle lies at the level
(a) The sternal angle lies at the level of the second intercostal space. False
The sternal angle lies at the level of the second costal cartilage.
(b) The sternal angle lies at the level of the intervertebral disc between the 5th and 6th thoracic vertebrae
False
The sternal angle lies at the level of the intervertebral disc between the 4th and 5th thoracic vertebrae.
(c) The sternal angle lies at the level of the junction of the ascending aorta and the aortic arch but not at the
junction between the descending aorta and the aortic arch. False
The sternal angle lies at the level of the junction of the ascending aorta and the aortic arch ( and also the
junction between the aortic arch and the descending aorta )
(d) The sternal angle lies at the level of the junction between the superior and inferior mediastinum. True
The sternal angle lies at the level of the junction between the superior and inferior mediastinum.
(e) The sternal angle lies at the level of the bifurcation of the trachea. True
The sternal angle lies at the level of the bifurcation of the trachea.
The sternal angle lies at the level of the second costal cartilage.As well as the above it lies at the junction of
the superior and inferior mediastinum.
47. Abnormal JVP:
(a) Giant 'v' waves are seen in tricuspid regurgitation. True

?Giant 'v' waves are seen in tricuspid regurgitation.
(b) No 'a' waves are seen in A Fib. True
?No 'a' waves are seen in A Fib.
(c) Inspiratory filling is normal. False
?Kussmaul's sign is seen in pericardial constriction, tamponade and severe asthma.
(d) Renal Failure may cause an abnormal JVP. True
?Pericarditis or fluid overload.
(e) Cannon waves are seen in ventricular tachycardia. True
?Cannon waves are seen in ventricular tachycardia and complete heart block.
48. Cervical Spondylosis
(a) When severe most commonly effects C5/C6 True
MCEM MCQ Anatomy

(b) Causing pain in the neck requires neck immobilisation False
(c) May produce symptoms of vertebrobasilar insufficiency. True
(d) Myelopathy is best treated with manipulation. False
(e) Radiculopathy rarely recovers completely. False
Cervical Spondylosis -When severe most commonly effects C5/C6 as this is where bending the neck is
greatest. Most episodes settle without treatment.Disc protrusion may narrow the vertebral arteries and
cause vertebrobasilar insufficiency.Manipulation is contraindicated in myelopathy.
49. The following are causes of spinal cord compression:
(a) Spondylosis. True

?
(b) Lymphoma. True
?
(c) Abscess. True
?
(d) Syringomyelia. True
?
(e) Haematomyelia. True
?
Syringomyelia and Haematomyelia are causes of intramedullary spinal cord compression. Other causes
include trauma, prolapsed disc, and tumors.
50. Veins of the Upper Limb:
(a) All veins in the upper limb possess valves. True

?All veins in the upper limb possess valves.
(b) The cephalic vein originates from the medial side of the venous network on the dorsum of the hand.
False
?The cephalic vein originates from the postero-lateral aspect of the venous network on the dorsum of the
hand.
(c) The cephalic vein passes upwards along the lateral border of the forearm anterior to the head of the
radius True
?The cephalic vein passes upwards along the lateral border of the forearm anterior to the head of the
radius
(d) In the upper arm the cephalic vein ascends on the lateral aspect of the biceps brachii to the groove
between the deltoid and pectoralis major True
?In the upper arm the cephalic vein ascends on the lateral aspect of the biceps brachii to the groove
between the deltoid and pectoralis major
(e) The basilic vein begins on the medial side of the venous network on the dorsum of the hand. True
?The basilic vein begins on the medial side of the venous network on the dorsum of the hand.
MCEM MCQ Anatomy

51. Pelvis X Rays:
(a) The urethra and bladder lie close to the pubic symphysis are damaged by a majority of traumatic
injuries to this area. False
?The urethra and bladder lie close to the pubic symphysis and are sometimes damaged by trauma to this
area (In 1/5 th of cases)
(b) For the pubic bones to separate by over 2.5 cm one or both of the ligaments have to be torn. True
?For the pubic bones to separate by over 2.5 cm one or both of the ligaments have to be torn.
(c) It is only possible to obtain the correct diagnosis in 50% of cases from AP views of the pelvis alone.
False
?In 94% of cases a correct diagnosis can be made from only AP views of the pelvis
(d) The pelvic brim is often disrupted in only one place False
?The pelvic brim cannot be disrupted in only one place
(e) Lateral compression fracture causes a disruption of the ala of the sacrum and a horizontal fracture of
the ipsilateral pubic symphysis True
?And momentary medial displacement of the hemipelvis
52. The following joints are often subluxed/dislocated in ehlers-danlos syndrome:
(a) Patella True

?The patella is often subluxed/dislocated in ehler-danlos syndrome
(b) Shoulder Joint True
?The shoulder joint is often subluxed/dislocated in ehler-danlos syndrome.
(c) The temporomandibular joint True
?The temporomandibular joint is often subluxed/dislocated in ehler-danlos syndrome.
(d) The subtalar joint True
?The subtalar joint is often subluxed/dislocated in ehler-danlos syndrome.
Ehlers-danlos syndrome comprises joint hypermobility, skin hyperextensibility,scar dystrophica and
excessive bleeding.
53. Diagnostic Peritoneal lavage is positive when
(a) RBC's >1,000 cells/mm3 False

?RBC's >100,000 cells/mm3
(b) WBC's >100 cells/mm3 False
?>500 cells/mm3
(c) Food Particles True
?
(d) Bile True
?
(e) Faeces True
?
Also 5ml gross blood, or exit of lavage fluid via chest tube or bladder catheter
MCEM MCQ Anatomy

54. Brachioradialis:
(a) Flexes arm at the elbow. True

?Brachioradialis flexes the arm at the elbow.
(b) Supinates the forearm. False
Supination of the forearm is the action of the biceps brachii.
(c) Brings forearm into midprone position. True
?Brachioradialis brings the forearm into the midprone position.
(d) Brachioradialis is innervated by ulnar nerve. False
Brachioradialis is innervated by the radial nerve.
(e) Overlies ulnar artery. False
?Brachioradialis overlies the radial artery.
55. The Optic Nerve:
(a) A bitemporal hemianopia may be caused by a pituitary tumor or a sella meningioma. True
?A bitemporal hemianopia may be caused by a pituitary tumor or a sella meningioma
(b) A homonymous hemianopia is caused by a lesion of the optic tract to the occipital cortex. True
?A homonymous hemianopia is caused by a lesion of the optic tract to the occipital cortex.
(c) An incomplete lesion of the optic tract is associated with a central scotomata. False
?An incomplete lesion of the optic tract is associated with macular ( central ) vision sparing
(d) An upper quadrant homonymous hemianopia is associated with a parietal lobe lesion. False
?A lower quadrant homonymous hemianopia is associated with a parietal lobe lesion.
(e) A lower quadrant homonymous hemianopia is associated with a temporal lobe lesion. False
?An upper quadrant homonymous hemianopia is associated with a temporal lobe lesion.
56. Thoracic vertebrae:
(a) The top of the arch of the aorta is at the level of T3/4 True
?The top of the arch of the aorta is at the level of T3/4
(b) The manubrium sterni encompasses levels T3 and T4 True
?The manubrium sterni encompasses levels T3 and T4
(c) The azygous vein enters the SVC at T6 False
?The azygous vein enters the SVC at T4
(d) The angle of louis is at the level of T4/5 True
?The angle of louis is at the level of T4/5
(e) The bifurcation of the trachea is at the level of T4/T5 True
?The bifurcation of the trachea is at the level of T4/T5
MCEM MCQ Anatomy

57. Wound Evaluation
(a) Diffuse bleeding most often occurs from the subdermal plexus and superficial veins True
? Diffuse bleeding most often occurs from the subdermal plexus and superficial veins
(b) Povidone-iodine based skin disinfectant suppress bacterial growth on intact skin. True
?
(c) Povidone-iodine based skin disinfectant should be used in the wound itslf to suppress bacterial growth.
False
?Povidone-iodine based skin disinfectant should not be used in the wound itself as it may impair host
defences and promote bacteria growth.
(d) Chlorhexidine based skin disinfectant should be used in the wound itslf to suppress bacterial growth.
False
?Chlorhexidine based skin disinfectant should not be used in the wound itself as it may impair host
defences and promote bacteria growth.
(e) In well perfused tissues (e.g., scalp) wounds closed without prior hair removal heal with an increase in
infection. False
?In well perfused tissues (e.g., scalp) wounds closed without prior hair removal heal with no apparent
increase in infection
58. The circle of willis is supplied by
(a) External carotid arteries False

?The circle of willis is supplied by the internal carotid.
(b) Basilar arteries True
?The basilar artery gives off the pontine, labyrinthine, superior and anterior inferior cerebellar arteries.
(c) Union of vertebral arteries True
?
(d) Brachial Artery False
?
(e) Axillary artery False
?
59. Central Vein Cannulation Complications include:
(a) Arterial laceration. True

After failure of placement, this is the commonest complication of central line insertion.
(b) Tension pneumothorax. True
(c) Haemothorax is increased with IJV cannulation when compared to the subclavian route. False
(d) Cardiac Tamponade. True
?Can be caused if the tip of the line lies below the pericardial reflection and it perforates the vessel wall. It's
least likely to happen via the internal jugular vein
(e) Air Embolism. True
Other complications during placement can be nerve injury. After placement local infection or venous
thrombosis can be possible complications.
MCEM MCQ Anatomy

60. Hand Infections
(a) The hand position of function for splinting includes the MCP joint being at 50 to 90 degrees flexion.
True
?
(b) Midpalmer space infection occurs from spread of a flexor tenosynovitis or from a penetrating wound to
the palm causing infection in the radial or ulnar bursa of the hand. True
?
(c) Paronychia is an infection of the lateral nail fold. True
?
(d) Flexor tenosynovitis is suggested by tenderness over the flexor tendon sheath. True
?
(e) Closed fist injury ( human bite wound above the MCP joint resulting from punching an individual ) be be
explored, irrigated and allowed to heal by secondary intention. True
?
61. Eye Trauma:
(a) A hyphema is not a reflection on the degree of trauma sustained. False

?A hyphema suggests significant ocular trauma.
(b) Restricted upward gaze suggests a blow out fracture with entrapment of the inferior rectus. True
?Restricted upward gaze suggests a blow out fracture with entrapment of the inferior rectus.
(c) A ruptured globe is implied by a flat anterior chamber. True
?A ruptured globe is implied by a flat anterior chamber.
(d) The sensation of the inferior orbital nerve is tested below the eye and on the ipsilateral side of the nose.
True
?The sensation of the inferior orbital nerve is tested below the eye and on the ipsilateral side of the nose.
(e) The pupil can be constricted or dilated after sustaining trauma. True
?The pupil can be constricted or dilated after sustaining trauma.
Blowout fractures are the most common orbital fractures. These injuries occur when a blunt object strikes
the globe, resulting in expansion of orbital contents and subsequent rupture through the bony floor. Patients
may have enophthalmos, or sunken globe, when a large section is ruptured. Infraorbital anesthesia is a
more common finding and develops when the infraorbital nerve is contused by the initial trauma or when
compressed by bony fragments. Anesthesia of the maxillary teeth and upper lip is more reliable than
numbness over the cheek. Diplopia, particularly on upward gaze that usually indicates inferior rectus
muscle entrapment, is another important clinical finding. A step-off deformity may be palpated over the
intraorbital rim. Subcutaneous emphysema is pathognomonic for fracture into a sinus or nasal antrum.
62. An ulnar nerve lesion may be represented as follows:
(a) Hyperextension at the MCP joint of the little and ring fingers accompanied by flexion of the
interphalangeal joints. True
?This is claw-like hand pattern.Hyperextension at the MCP joint of the little and ring fingers accompanied
by flexion of the interphalangeal joints.
(b) Clawing of the hand is more pronounced with a more proximal lesion. False
?Clawing of the hand is more pronounced with a lesion at the wrist as a lesion at or above the elbow
causes loss of flexor digitorum profundus and less flexion at the IP joints.
MCEM MCQ Anatomy

(c) Froments sign tests thumb adduction. True
?The patient is asked to grasp a piece of paper between the thumb and the lateral aspect of the index
finger.
(d) The ulnar nerve supplies the sensory component to the medial half of the ring finger. True
?The ulnar nerve supplies the sensory component to the medial half of the ring finger.
(a) Knee flexion is performed by the quadriceps. False

?Knee flexion is performed by the hamstrings!
(b) The hamstrings are innervated by the obturator nerve. False
?The hamstrings are innervated by the sciatic nerve.
(c) The sciatic nerve innervates the quadriceps. False
?The femoral nerve(L2/3/4) innervates the quadriceps.
(d) The obturator nerve is composed of fibers from L2,L3 and L4. True
?The obturator nerve is composed of fibers from L2,L3 and L4.
(e) The sciatic nerve is responsible for ankle dorsiflexion True
?The common peroneal nerve is an extension of the sciatic nerve.
Knee flexion is performed by the hamstrings which are innervated by the sciatic nerve(S1). The sciatic
nerve is responsible for ankle dorsiflexion via the common peroneal nerve. The obturator nerve is
composed of fibers from L2,L3 and L4.
64. Ureters
(a) Each ureter measures approximately 10cm in length False

?Each ureter measures approximately 25cm ( 10 inches ) in length
(b) Pass into the anterior surface of the urinary bladder False
?Each ureter passes into the posterior surface of the urinary bladder.
(c) Ureteric stones frequently arrest where the renal pelvis joins the ureter. True
?Ureteric stones frequently arrest where the renal pelvis joins the ureter, where the ureter is kinked as it
passes the pelvic brim and where the ureter pierces the bladder wall.
(d) Are supplied in the inferior end by the renal arteries. False
?The upper end is supplied by the renal arteries, the middle is supplied by the testicular or the ovarian
artery and the inferior end is supplied by the superior vesical artery.
(e) Lymph drainage is to the lateral aortic and iliac nodes. True
?Lymph drainage is to the lateral aortic and iliac nodes.
65. Lumbar Plexus:
(a) The lumbar plexus is formed by the anterior rami of the upper four lumbar nerves. True
?The lumbar plexus is formed by the anterior rami of the upper four lumbar nerves.
(b) It is situated within the psoas muscle True
?It is situated within the psoas muscle
(c) The femoral nerve originates from the lumbar plexus from L1 and L2. False
?The femoral nerve originates from the lumbar plexus from L2, L3 and L4
MCEM MCQ Anatomy

(d) The obturator nerve originates from L1 and L2. False
?The obturator nerve originates from L2, L3 and L4
(e) The obturator nerve innervates the adductors of the thigh and the skin on the medial surface of the
thigh. True
?The obturator nerve innervates the adductors of the thigh and the skin on the medial surface of the thigh.
66. The following are correct:
(a) The oesophageal opening in the diaphragm is at the level of T8 False

?The oesophageal opening in the diaphragm is at the level of T10
(b) Branches of the right gastric vessels go through the diaphragm at T10 False
?Branches of the left gastric vessels go through the diaphragm at T10
(c) The left phrenic nerve pierces the diaphragm lateral to the central tendon at the level of T6 False
?The left phrenic nerve pierces the diaphragm lateral to the central tendon at the level of T8
(d) The right phrenic nerve pierces the diaphragm with the IVC at T6 False
?The right phrenic nerve pierces the diaphragm with the IVC at T8
(e) The sternoxiphisternal joint is at the level of T8/9 True
?The sternoxiphisternal joint is at the level of T8/9
(a) The ulnar nerve is largely made up from C6 and C7 fibres. False
?The ulnar nerve is largely made up from C8 and T1 fibres.
(b) The axillary nerve is given off by the posterior cord. True
?The axillary nerve is given off by the posterior cord.
(c) The musculocutaneous nerve is made up from C5 , C6 , and C7 True
?The musculocutaneous nerve is made up from C5 , C6 , and C7
(d) The medial cord and the lateral cord form the median nerve True
?The medial cord and the lateral cord form the median nerve
(e) The dorsal scapular nerve ( C5 ) supplies the serratus anterior muscle. False
?The dorsal scapular nerve ( C5 ) supplies the rhomboid muscles. Serratus Anterior is supplied by the long
thoracic nerve.
68. The following are true in relation to common root compression syndromes produced by lumbar disc
prolapse:
(a) An L5 root lesion will cause pain from the buttock to the lateral aspect of the leg and on the dorsum of
the foot. True
?An L5 root lesion will cause pain from the buttock to the lateral aspect of the leg and on the dorsum of the
foot.
(b) An L4 root lesion will cause pain from the lateral aspect of the thigh to the medial side of the calf. True
?An L4 root lesion will cause pain from the lateral aspect of the thigh to the medial side of the calf.
(c) An S1 root lesion will cause sensory loss on the sole of the foot and the posterior calf. True
?An S1 root lesion will cause sensory loss on the sole of the foot and the posterior calf.
(d) An L5 root lesion will cause sensory loss on the dorsum of the foot and anterolateral aspect of the leg.
True
?An L5 root lesion will cause sensory loss on the dorsum of the foot and anterolateral aspect of the leg.
MCEM MCQ Anatomy

(a) In the axilla the posterior divisions unite to form the posterior cord True
?In the axilla the posterior divisions unite to form the posterior cord
(b) The lateral cord supplies the extensor structures on the posterior aspect of the limb. False
?The posterior cord supplies the extensor structures on the posterior aspect of the limb.
(c) The posterior division of the lower trunk forms the medial cord. False
?The anterior division of the lower trunk forms the medial cord.
(d) The posterior cord may contain neurons from all the spinal nerves contributing to the brachial plexus
True
?The posterior cord may contain neurons from all the spinal nerves contributing to the brachial plexus
(e) The dorsal scapular nerve is a branch of C5. True
?The dorsal scapular nerve is a branch of C5
70. Fissure In Ano
(a) Cause painless rectal bleeding False
?Is a common casue of painful rectal bleeding
(b) In most cases occur in the midline anteriorly False
?In most cases occur in the midline posteriorly.
(c) Discomfort is constant between bowel motions. False
?Discomfort resolves between bowel motions.
(d) Are associated with sentinel pile's True
?As a result of hypertrophied papillae.
(e) Patient's should increase dietary bran True
?
71. Lumbar Puncture:
(a) The plane of the iliac crest runs through L1-L2. False
?The plane of the iliac crest runs through L3-L4.
(b) The spinal cord in the adult ends at the level of L1-2. True
?The spinal cord in the adult ends at the level of L1-2.
(c) When performing a lumbar puncture the 'give' is felt when passing through the interspinous ligament.
False
?The 'give' is felt when passing through the ligamentum flavum.
(d) The opening pressure is usually <10 cm of CSF. False
?The opening pressure is usually 7-18cm of CSF.
(e) The CSF protein content is usually 0.15 to 0.45g/L. True
?Other important values include WCC <5. For every 1000 RBC's, subtract 1 WBC and 0.015 protein.
Headache, which occurs in 10 to 30% of patients, is one of the most common complications following
lumbar puncture (LP). Post-LP headache is caused by leakage of CSF from the dura and traction on painsensitive structures. Patients characteristically present with frontal or occipital headache within 24 to 48
hours of the procedure, which is exacerbated in an upright position and improved in the supine position.
Associated symptoms may include nausea, vomiting, dizziness, tinnitus, and visual changes.
MCEM MCQ Anatomy

72. Haemorrhagic shock classification
(a) Class I loss is usually <750 ml True
?Class I loss is usually <750 ml
(b) Class II loss is usually < 2000 ml False
?Class II loss is usually < 1500 ml
(c) Class III shock is <2.5L blood loss False
?Class III shock is <2L blood loss
(d) Without intervention, a classic bimodal distribution of deaths is seen in severe hemorrhagic shock.
False
Without intervention, a classic trimodal distribution of deaths is seen in severe hemorrhagic shock. An initial
peak of mortality occurs within minutes of hemorrhage due to immediate exsanguination. Another peak
occurs after 1 to several hours due to progressive decompensation. A third peak occurs days to weeks later
due to sepsis and organ failure.
(e) Lower doses of Dopamine predominantly stimulate dopaminergic receptors that in turn produce renal
vasodilation and cardiac stimulation. False
Lower doses predominantly stimulate dopaminergic receptors that in turn produce renal and mesenteric
vasodilation. Higher doses produce cardiac stimulation and renal vasodilation
http://www.emedicine.com/emerg/topic531.htm
Class I = <750ml, Class II = <1.5L, Class III= <2L, Class IV = >2L

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MCEM MCQ Anatomy

In which the talus is driven into the calcaneus. Or a twisting injury.

(d) Internuclear opthalmoplegia occurs when there is failure of adduction of one

(e) Quadriceps tendon rupture is most common is individuals under 40 years of

23% of the time.

3. The Subclavian Artery:

MCEM MCQ Anatomy

MCEM MCQ Anatomy

(d) Somatosensory=postcentral gyrus

(e) Visual= Calcarine sulcus

In the occipital cortex

MCEM MCQ Anatomy

MCEM MCQ Anatomy

Most chest X Ray's do show abnormalities. Among the most common

MCEM MCQ Anatomy

MCEM MCQ Anatomy

(d) A teardrop sign is associated with an orbital margin fracture

Treatment consists of a thumb spica splint and orthopaedic referral.

A feature of a downward blow out fracture

MCEM MCQ Anatomy

(b) raising intra abdominal pressure to assist in micturition

(c) helps in weight lifting

(d) Assists in return of blood to the right side of the heart

(e) Assists in initiation of movement

(d) Gastric bubbling noises are heard over the epigastrium.

MCEM MCQ Anatomy

MCEM MCQ Anatomy

MCEM MCQ Anatomy

(c) On ECG may be represented by dysrhythmia's

(d) On Trans Thoracic two dimensional echo may be represented by focal or

(e) Dysrhythmias should be managed conservatively

(c) The triceps is innervated by the radial nerve

(d) The supinator reflex is innervated by the radial nerve

(e) The knee jerk tests knee flexion

Especially with fractures to sternum or anterior ribs

MCEM MCQ Anatomy

PUD causes about 60% of all upper GI bleeds

MCEM MCQ Anatomy

Orbital cellulitis is but peri-orbital cellulitis is not.

MCEM MCQ Anatomy

(b) Carotid artery aneursym

(c) Posterior Communicating Artery Aneursym

(d) Nasopharyngeal tumor spread

(e) Wegeners Granulomatosis

Or any other cause of infection such as sinusitis or tuberculosis

MCEM MCQ Anatomy

(b) Class II shock usually do not have any mental anxiety

(c) Class III patients usually have some anxiety

(d) Class IV patients are usually alert and not confused

(e) Class II patients are usually confused

MCEM MCQ Anatomy

The internal spermatic fascia is derived from the transversalis fascia

MCEM MCQ Anatomy

(c) High velocity injuries usually have less bacterial contamination

(d) Abdominal gunshot wounds invariably require laparotomy.

(e) Cranial gunshot wounds invariably require ventilation.

(e) The vagus nerve supplies the external auditory canal.

The renal arteries originate at the vetebral level of L1/2.

53. With regard to innervation of the ear

MCEM MCQ Anatomy

MCEM MCQ Anatomy

(a) The pharynx becomes the oesophagus at C6 True

MCEM MCQ Anatomy